Provider Demographics
NPI:1235450040
Name:GONZALEZ-BROWN, RICHELLE ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHELLE
Middle Name:ANGELA
Last Name:GONZALEZ-BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HIGHWAY 74 S STE 6-162
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3073
Mailing Address - Country:US
Mailing Address - Phone:678-372-7732
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGHWAY 74 S STE 6-162
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3073
Practice Address - Country:US
Practice Address - Phone:678-372-7732
Practice Address - Fax:678-372-7732
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA070121208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137166BMedicaid
GA003137166CMedicaid
AL160719Medicaid