Provider Demographics
NPI:1336176403
Name:GONZALEZ, ANDREA (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 WALTON WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4163
Mailing Address - Country:US
Mailing Address - Phone:706-790-4440
Mailing Address - Fax:
Practice Address - Street 1:13700 SAINT FRANCIS BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3267
Practice Address - Country:US
Practice Address - Phone:804-276-7125
Practice Address - Fax:804-276-7126
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83389207RI0200X
VA0101233019207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010203406Medicaid