Provider Demographics
NPI:1437329661
Name:MENDOZA, ALDRICH VILLAMIN (MD)
Entity type:Individual
Prefix:
First Name:ALDRICH
Middle Name:VILLAMIN
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1882
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:706-509-4600
Practice Address - Street 1:251 HIGHWAY 53 E
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3026
Practice Address - Country:US
Practice Address - Phone:706-625-4410
Practice Address - Fax:706-625-4447
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine