Individual
ELMAN OTNIEL GONZALES HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2615 E WEST CONNECTOR STE 106, AUSTELL, GA 30106-6854
(770) 941-0010
(770) 941-0154
Mailing address
804 SNAPDRAGON RD, SEVIERVILLE, TN 37876-5830
(865) 384-1458
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363AM0700X
Medical Physician Assistant
Primary
12891
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2023
Last updated
05/06/2025
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