Healthcare Provider Details

I. General information

NPI: 1417445206
Provider Name (Legal Business Name): KAMLA GONZALES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5146 MILLER WOODS TRL
DECATUR GA
30035
US

IV. Provider business mailing address

5146 MILLER WOODS TRL
DECATUR GA
30035-3746
US

V. Phone/Fax

Practice location:
  • Phone: 347-528-4006
  • Fax:
Mailing address:
  • Phone: 347-528-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN249592
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number113293-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN249592
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: