Individual
JOSE LUIS DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 FOUNTAIN DR STE A, SNELLVILLE, GA 30078-2900
(770) 736-3008
Mailing address
4517 LAVISTA RD, TUCKER, GA 30084-4208
(770) 723-1226
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36190
GA
Other
Enumeration date
09/24/2006
Last updated
04/15/2019
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