Provider Demographics
NPI:1518385111
Name:VELAZQUEZ, ERIC PAUL (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:PAUL
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8639
Mailing Address - Country:US
Mailing Address - Phone:478-633-8391
Mailing Address - Fax:478-633-8395
Practice Address - Street 1:1062 FORSYTH ST STE 2D
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8639
Practice Address - Country:US
Practice Address - Phone:478-633-8391
Practice Address - Fax:478-633-8395
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA868342080P0205X, 208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics