Healthcare Provider Details

I. General information

NPI: 1609556984
Provider Name (Legal Business Name): JOSI MARGARITE GIOVINAZZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 WARRIOR WAY
GROVETOWN GA
30813-8132
US

IV. Provider business mailing address

1520 SCHLEY ST
AUGUSTA GA
30904-6214
US

V. Phone/Fax

Practice location:
  • Phone: 706-664-0744
  • Fax:
Mailing address:
  • Phone: 240-446-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: