Healthcare Provider Details

I. General information

NPI: 1013611391
Provider Name (Legal Business Name): ANDREA LEONOR GONZALEZ OJEDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK STREET MSC 165
MACON GA
31201-2102
US

IV. Provider business mailing address

777 HEMLOCK STREET MSC 165
MACON GA
31201-2102
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-1634
  • Fax: 478-633-1578
Mailing address:
  • Phone: 478-633-1634
  • Fax: 478-633-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15055
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: