Healthcare Provider Details

I. General information

NPI: 1497782049
Provider Name (Legal Business Name): CYNTHIA GONZALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATES AVE
SAVANNAH GA
31404
US

IV. Provider business mailing address

4700 WATES AVE
SAVANNAH GA
31404
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-5646
  • Fax: 912-350-8427
Mailing address:
  • Phone: 912-350-5646
  • Fax: 912-350-8427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number054882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: