Provider Demographics
NPI:1326264904
Name:GONZALEZ, AMY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4203
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4540
Mailing Address - Country:US
Mailing Address - Phone:770-831-3018
Mailing Address - Fax:
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4203
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4540
Practice Address - Country:US
Practice Address - Phone:770-831-3018
Practice Address - Fax:770-831-3669
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA054213207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I110872Medicare UPIN
GA511I110143Medicare UPIN
GA511G700201Medicare PIN