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General NPI Number Information
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NPI Number | 1003992157
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Entity Type | Individual
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Provider Name | JOY GAVINO
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 214 ROME AVE
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City | PIEDMONT
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State | AL
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Zip | 36272-1920
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Country | US
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Telephone | 256-447-6262
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Fax | 256-447-6211
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | JACKSONVILLE
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State | AL
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Zip | 36265-0550
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Country | US
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Telephone | 256-447-6262
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Fax | 256-447-6211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25405
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License Number State | AL
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