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NPI Code Detail

MEDICARE: TERESA GONZALEZ-HOMAN PA-C

MEDICARE:   TERESA  GONZALEZ-HOMAN  PA-C
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
1363AM0700XMedical Physician Assistant004040GA
2207P00000XEmergency Medicine Physician004040GA

General Provider Information

NPI Number : 1487759452
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA GONZALEZ-HOMAN PA-C
Provider Business Mailing Address
First Line : 14415 WYNDHAM FARMS DR
Second Line :
City : MILTON
State : GA
Zip : 30004-4359
Country : US
Telephone Number : 678-361-6720
Fax Number :
Provider Business Practice Location Address
First Line : 3500 LENOX RD NE STE 1500
Second Line :
City : ATLANTA
State : GA
Zip : 30326-4231
Country : US
Telephone Number : 678-361-6720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 10/16/2020

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Directions to “ TERESA GONZALEZ-HOMAN PA-C” Practice Location

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