Healthcare Provider Details

I. General information

NPI: 1548885072
Provider Name (Legal Business Name): RICARDO J HERNANDEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 JOHNS CREEK PKWY STE 100
SUWANEE GA
30024-5683
US

IV. Provider business mailing address

4025 JOHNS CREEK PKWY STE 100
SUWANEE GA
30024-5683
US

V. Phone/Fax

Practice location:
  • Phone: 404-575-4500
  • Fax: 404-575-4555
Mailing address:
  • Phone: 404-575-4500
  • Fax: 404-575-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number112073
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: