Provider Demographics
NPI:1437713112
Name:D'ANNUNZIO, JEREMIAH A (PNP)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:A
Last Name:D'ANNUNZIO
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HANNAHS MILL RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-2801
Mailing Address - Country:US
Mailing Address - Phone:706-938-0990
Mailing Address - Fax:706-647-3861
Practice Address - Street 1:210 HANNAHS MILL RD
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-2801
Practice Address - Country:US
Practice Address - Phone:706-938-0990
Practice Address - Fax:706-647-3861
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284896208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics