Provider Demographics
NPI:1073891198
Name:PENA, JULIO ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:ERNESTO
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1360 CADUCEUS WAY
Mailing Address - Street 2:BLDG 400, SUITE 104
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7300
Mailing Address - Country:US
Mailing Address - Phone:706-850-8135
Mailing Address - Fax:706-548-9101
Practice Address - Street 1:1360 CADUCEUS WAY
Practice Address - Street 2:BLDG 400, SUITE 104
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7300
Practice Address - Country:US
Practice Address - Phone:706-850-8135
Practice Address - Fax:706-548-9101
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2016-07-18
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Provider Licenses
StateLicense IDTaxonomies
GA75119207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology