Provider Demographics
NPI:1497782049
Name:GONZALES, CYNTHIA (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATES AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404
Mailing Address - Country:US
Mailing Address - Phone:912-350-5646
Mailing Address - Fax:912-350-8427
Practice Address - Street 1:4700 WATES AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-5646
Practice Address - Fax:912-350-8427
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0548822080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA070747455DMedicaid
GA10065462OtherAMERIGROUP
GA349774OtherWELLCARE
GA070747455CMedicaid
GA070747455AMedicaid
GA070747455BMedicaid
SCG54882Medicaid
GA37BBGQQMedicare PIN
SCG54882Medicaid