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General NPI Number Information
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NPI Number | 1285921171
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Entity Type | Individual
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Provider Name | JOSE L. FERNANDEZ-GERENA MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 1040 EAGLES LANDING PARKWAY SUITE 100
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9073
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Country | US
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Telephone | 770-474-7287
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Fax | 770-389-3713
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Provider Business Mailing Address
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Address Line | 1040 EAGLES LANDING PARKWAY SUITE 100
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9073
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Country | US
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Telephone | 770-474-7287
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Fax | 770-389-3713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301099137
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 075622
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License Number State | GA
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