Healthcare Provider Details

I. General information

NPI: 1891011805
Provider Name (Legal Business Name): FELIX M GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 EXECUTIVE PARK S
ATLANTA GA
30329-2208
US

IV. Provider business mailing address

4061 POWDER MILL RD SUITE 210
CALVERTON MD
20705-3149
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6264
  • Fax:
Mailing address:
  • Phone: 202-669-8501
  • Fax: 240-846-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0071654
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: