Individual
JUAN ISRAEL GAITAN RUEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(404) 367-3014
Mailing address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(404) 367-3014
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
076716
GA
207RP1001X
Pulmonary Disease Physician
Primary
076716
GA
Other
Enumeration date
07/08/2008
Last updated
01/02/2017
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