Provider Demographics
NPI:1457977563
Name:GONZALEZ GUZMAN, JENNY TATIANA (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:TATIANA
Last Name:GONZALEZ GUZMAN
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PRISMA HEALTH FAMILY MEDICAL CENTER
Mailing Address - Street 2:3209 COLONIAL DRIVE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6113
Mailing Address - Fax:803-434-8478
Practice Address - Street 1:PRISMA HEALTH FAMILY MEDICAL CENTER
Practice Address - Street 2:3209 COLONIAL DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6113
Practice Address - Fax:803-434-8478
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL84579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine