MEDICARE: ANDREA GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	83389	GA
2	207RI0200X	Infectious Disease Physician	0101233019	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336176403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	2050 WALTON WAY
Second Line	:	STE 101
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4163
Country	:	US
Telephone Number	:	706-790-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	13700 SAINT FRANCIS BLVD
Second Line	:	SUITE 510
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-3267
Country	:	US
Telephone Number	:	804-276-7125
Fax Number	:	804-276-7126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	10/29/2019

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