Provider Demographics
NPI:1174107718
Name:BOCHICCHIO, GIANNA VALENTINA (AEMT)
Entity type:Individual
Prefix:
First Name:GIANNA
Middle Name:VALENTINA
Last Name:BOCHICCHIO
Suffix:
Gender:F
Credentials:AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 RILANDITE CV
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6607
Mailing Address - Country:US
Mailing Address - Phone:678-882-2565
Mailing Address - Fax:
Practice Address - Street 1:110 SAMARITAN DR STE 205
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2569
Practice Address - Country:US
Practice Address - Phone:678-456-8704
Practice Address - Fax:678-807-2938
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA031307146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Provider Identifiers
StateIdentifier IDID TypeIssuer
A2033819OtherNATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS (NREMT)
GAA031307OtherGEORGIA DEPARTMENT OF PUBLIC HEALTH