Individual
JESSICA GONZALEZ HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
CAROLINA SURGICAL ASSOCIATES EASTSIDE, 135 COMMONWEALTH DRIVE STE 210, GREENVILLE, SC 29615-4850
(864) 675-4815
(877) 893-3779
Mailing address
PO BOX 743294, ATLANTA, GA 30374-3294
(787) 349-0120
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
61156
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
611564
—
SC
Enumeration date
04/15/2011
Last updated
02/20/2019
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