Provider Demographics
NPI:1760903330
Name:CONTRERAS ANEZ, GUSTAVO ADOLFO (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ADOLFO
Last Name:CONTRERAS ANEZ
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 1:7823 SPIVEY STATION BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2886
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:
Practice Address - Street 1:7823 SPIVEY STATION BLVD STE 360
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2886
Practice Address - Country:US
Practice Address - Phone:770-741-1750
Practice Address - Fax:770-741-1755
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA93159207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program