Provider Demographics
NPI:1457701542
Name:GONZALEZ-JACOBO, ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:GONZALEZ-JACOBO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 CUMBERLAND PKWY SE STE 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7004
Mailing Address - Country:US
Mailing Address - Phone:678-626-0909
Mailing Address - Fax:678-626-0909
Practice Address - Street 1:2303 CUMBERLAND PKWY SE STE 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7004
Practice Address - Country:US
Practice Address - Phone:678-626-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty