| Doctor Name: | MARIA FONDAL |
| NPI Number: | 1992987358 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D., FACR |
| License Number: | 045463 |
| Business Practice Address: | Suite 1000 6501 Peake Road Macon, GA - 31210 |
| Business Phone Number: | 4784751545 |
| Business Fax Number: | 4784755687 |
| Mailing Address: | Suite 1000, 6501 Peake Road MACON |
| State: | GA |
| Postal Code: | 31210 |
| Phone Number: | 4784751545 |
| Fax Number: | 4784755687 |
| NPI Enumeration Date: | 11/28/2007 |
| NPI Last Update Date: | 10/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 045463 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |