Provider Demographics
NPI:1134354798
Name:PAEZ-ZAPATA, ERICA (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PAEZ-ZAPATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:PAEZ-ZAPATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18 RIVERBEND DR SW STE 210
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6019
Mailing Address - Country:US
Mailing Address - Phone:706-528-4949
Mailing Address - Fax:706-204-8274
Practice Address - Street 1:18 RIVERBEND DR SW STE 210
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6019
Practice Address - Country:US
Practice Address - Phone:706-528-4949
Practice Address - Fax:706-204-8274
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075112208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA075112OtherGA COMPOSITE MEDICAL BOARD
GA102I370895OtherMEDICARE PTAN
GA003170656AMedicaid
GA003170656BMedicaid