Individual
DR. RAFAEL ANDRES PONCE TERASHIMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 PINE ST, MACON, GA 31201-2106
(478) 301-5800
(478) 301-5812
Mailing address
250 MARTIN LUTHER KING JR BLVD, MACON, GA 31201
(478) 301-2362
(478) 301-2272
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
070409
GA
207R00000X
Internal Medicine Physician
430109038
MI
207RI0200X
Infectious Disease Physician
Primary
070409
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136039
—
GA
Enumeration date
05/11/2010
Last updated
02/20/2019
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