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General NPI Number Information
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NPI Number | 1891891560
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Entity Type | Individual
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Provider Name | JUAN CARLOS GONZALEZ MD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1107 MEMORIAL DR STE 300
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City | DALTON
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State | GA
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Zip | 30720-8662
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Country | US
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Telephone | 706-275-6121
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Fax | 706-275-0521
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Provider Business Mailing Address
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Address Line | 1107 MEMORIAL DR STE 300
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City | DALTON
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State | GA
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Zip | 30720-8662
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Country | US
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Telephone | 706-275-6121
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Fax | 706-275-0521
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 068737
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 068737
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License Number State | GA
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