Basic Information
| Provider Information | |||||||||
| NPI: | 1679922603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRERO-CALDERON | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | DIEGO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365 CLIFTON RD NE STE C1104 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221013 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1365 CLIFTON RD NE STE C1104 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303226830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047784446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2016 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD.36647 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208D00000X | 32752-R | PR | N | Allopathic & Osteopathic Physicians | General Practice | 2085R0202X | 88669 | GA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.