Provider Demographics
NPI:1366484867
Name:JOSEPH D GIOVINCO DPM PC
Entity type:Organization
Organization Name:JOSEPH D GIOVINCO DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSUELO
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-854-1976
Mailing Address - Street 1:7130 MOUNT ZION BLVD
Mailing Address - Street 2:STE 14
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2566
Mailing Address - Country:US
Mailing Address - Phone:770-716-8732
Mailing Address - Fax:770-716-1330
Practice Address - Street 1:265 N JEFF DAVIS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1625
Practice Address - Country:US
Practice Address - Phone:770-716-8732
Practice Address - Fax:770-716-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000623213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1634Medicare PIN
GA0916620001Medicare NSC