Individual
MRS. GINA GONZALEZ JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1240 HIGHWAY 54 W, BUILDING 700, SUITE 700, FAYETTEVILLE, GA 30214-4557
(404) 452-9931
Mailing address
1240 HIGHWAY 54 W, BUILDING 700, SUITE 700, FAYETTEVILLE, GA 30214-4557
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
051480
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
358717674A
—
GA
Enumeration date
12/12/2006
Last updated
01/28/2020
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