Individual
FREYLI J BUSTAMANTE GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-7401
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
009840
GA
Other
Enumeration date
04/13/2018
Last updated
10/11/2023
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