Provider Demographics
NPI:1477603447
Name:HERNANDEZ, CARLOS FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:FERNANDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:CAMARERO
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:145 TECHNOLOGY PARKWAY NW
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2319
Mailing Address - Country:US
Mailing Address - Phone:800-780-3500
Mailing Address - Fax:
Practice Address - Street 1:145 TECHNOLOGY PARKWAY NW
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2319
Practice Address - Country:US
Practice Address - Phone:800-780-3500
Practice Address - Fax:770-248-6710
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FG4530Medicare UPIN