Healthcare Provider Details

I. General information

NPI: 1043382369
Provider Name (Legal Business Name): JOSEPH F DEBOSKEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6392 SOUTH BIG A RD TRI COUNTY PODIATRY LLC
TOCCOA GA
30577
US

IV. Provider business mailing address

PO BOX 1266 TRI COUNTY PODIATRY LLC
TOCCOA GA
30577
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-5092
  • Fax: 706-282-5095
Mailing address:
  • Phone: 706-282-5092
  • Fax: 706-282-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD000724
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00629197B
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier480033316
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MCARE
# 3
Identifier553931
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: