Provider Demographics
NPI:1164448098
Name:HERNANDEZ, ERNESTO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:E
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:687 MARIETTA HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2608
Practice Address - Country:US
Practice Address - Phone:770-704-1955
Practice Address - Fax:770-720-2388
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA050581207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000940387DMedicaid
GA000940387FMedicaid
GA000940387HMedicaid
GA000940387EMedicaid
GAH16860Medicare UPIN
GA000940387FMedicaid