Provider Demographics
NPI:1417988981
Name:GONZALES, GEORGE P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:P
Last Name:GONZALES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 GREENWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1991
Mailing Address - Country:US
Mailing Address - Phone:658-687-3313
Mailing Address - Fax:865-687-3362
Practice Address - Street 1:2606 GREENWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1991
Practice Address - Country:US
Practice Address - Phone:865-687-3313
Practice Address - Fax:865-687-3362
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA504363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3666697Medicaid
TN10397I2996Medicare PIN
TNS20763Medicare UPIN
3666697Medicare PIN