Provider Demographics
NPI:1265229827
Name:NEAL, JACK HENRY GONZALEZ (MED, MS)
Entity type:Individual
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First Name:JACK
Middle Name:HENRY GONZALEZ
Last Name:NEAL
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Gender:
Credentials:MED, MS
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Mailing Address - Street 1:110 CARLTON ST ATHENS GA 30602 ROOM 424
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 CARLTON ST ATHENS GA 30602
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-0001
Practice Address - Country:US
Practice Address - Phone:706-542-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health