Provider Demographics
NPI:1437340270
Name:CACERES SERRANO, HECTOR ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:ALEJANDRO
Last Name:CACERES SERRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:690 DALLAS HWY STE 301
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1262
Practice Address - Country:US
Practice Address - Phone:770-812-3850
Practice Address - Fax:770-812-3826
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA078608207VX0000X
AL30891207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I160802Medicare PIN
AL102I160802Medicare PIN