Provider Demographics
NPI:1942886510
Name:GONZALEZ, WILAYNETH DEL CARMEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:WILAYNETH
Middle Name:DEL CARMEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WILAYNETH
Other - Middle Name:DEL CARMEN
Other - Last Name:RUBISTEIN CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1199 PRINCE AVE # 70
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2797
Mailing Address - Country:US
Mailing Address - Phone:706-475-7055
Mailing Address - Fax:
Practice Address - Street 1:1270 PRINCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2789
Practice Address - Country:US
Practice Address - Phone:706-475-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97732207R00000X
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine