Individual
HECTOR KEVIN GONZALEZ FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 TEBEAU ST, WAYCROSS, GA 31501-6357
(912) 283-3030
Mailing address
6301 RIVERWOODS DR, BLACKSHEAR, GA 31516-4662
(561) 597-6212
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
87737
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2018
Last updated
08/09/2021
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