Provider Demographics
NPI:1184005761
Name:GONZALEZ, CHELSEA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 CAMPUS LOOP RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3227
Mailing Address - Country:US
Mailing Address - Phone:470-578-7937
Mailing Address - Fax:
Practice Address - Street 1:3215 CAMPUS LOOP RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:470-578-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82591207Q00000X
MI5.10E09207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine