Healthcare Provider Details

I. General information

NPI: 1457315434
Provider Name (Legal Business Name): JAMES VINCENT PALAZZOLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W 3RD AVE
ALBANY GA
31701-1917
US

IV. Provider business mailing address

PO BOX 72105
ALBANY GA
31708-2105
US

V. Phone/Fax

Practice location:
  • Phone: 229-438-5864
  • Fax: 229-439-4769
Mailing address:
  • Phone: 229-438-5864
  • Fax: 229-438-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number037637
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: