Individual
ALFONSO CARLOS FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4084 N HENRY BLVD, STOCKBRIDGE, GA 30281-3809
(770) 474-7223
Mailing address
4084 N HENRY BLVD, STOCKBRIDGE, GA 30281-3809
(770) 474-7223
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN11980
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00818155B
—
GA
01
—
1205939899
NPI
GA
Enumeration date
07/24/2013
Last updated
07/24/2013
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