Individual
DR. ERICKA VANESA LI FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 301-2362
Mailing address
250 MARTIN LUTHER KING JR BLVD, MACON, GA 31201-3490
(478) 301-2362
(478) 301-2272
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
070321
GA
207R00000X
Internal Medicine Physician
35-131721
OH
207R00000X
Internal Medicine Physician
4301097388
MI
Other
Enumeration date
07/19/2010
Last updated
03/04/2019
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