Provider Demographics
NPI:1487759452
Name:GONZALEZ-HOMAN, TERESA (PA-C)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GONZALEZ-HOMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14415 WYNDHAM FARMS DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4359
Mailing Address - Country:US
Mailing Address - Phone:678-361-6720
Mailing Address - Fax:
Practice Address - Street 1:3500 LENOX RD NE STE 1500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-4231
Practice Address - Country:US
Practice Address - Phone:678-361-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004040363AM0700X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical