Provider Demographics
NPI:1497453583
Name:GONZALEZ, CHARMECIA (AGNPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARMECIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:AGNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1821
Mailing Address - Country:US
Mailing Address - Phone:770-696-2697
Mailing Address - Fax:
Practice Address - Street 1:8640 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-1821
Practice Address - Country:US
Practice Address - Phone:770-696-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program