Provider Demographics
NPI:1033202239
Name:GONZALEZ, JOSE MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MARTIN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3280 HOWELL MILL RD NW STE 150
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4102
Mailing Address - Country:US
Mailing Address - Phone:404-351-7467
Mailing Address - Fax:404-719-4121
Practice Address - Street 1:4890 ROSWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2606
Practice Address - Country:US
Practice Address - Phone:404-351-7467
Practice Address - Fax:404-719-4121
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG03946Medicare UPIN