Individual
DR. MIA DAVIELLE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
521 MOYE BLVD, GREENVILLE, NC 27834-2849
(252) 744-1600
(252) 744-1115
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2020-00026
NC
207R00000X
Internal Medicine Physician
2020-00026
NC
207RP1001X
Pulmonary Disease Physician
Primary
2020-00026
NC
Other
Enumeration date
05/19/2017
Last updated
11/26/2024
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