Healthcare Provider Details

I. General information

NPI: 1154397677
Provider Name (Legal Business Name): JOSEPH F BOVERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 11/19/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 GLENRIDGE DR
ATLANTA GA
30342-1342
US

IV. Provider business mailing address

1067 STOVALL BLVD NE
ATLANTA GA
30319-1220
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-3600
  • Fax: 404-481-2176
Mailing address:
  • Phone: 404-312-1047
  • Fax: 404-481-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number38693
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: