MEDICARE: DR. JENNIFER ANN MONACO D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	962	CT
2	213E00000X	Podiatrist	E4858	CA
3	213EP1101X	Primary Podiatric Medicine Podiatrist	962	CT
4	213EP1101X	Primary Podiatric Medicine Podiatrist	E4858	CA
5	213ES0000X	Sports Medicine Podiatrist	E4858	CA
6	213ES0103X	Foot & Ankle Surgery Podiatrist	E4858	CA
7	213ES0103X	Foot & Ankle Surgery Podiatrist	962	CT
8	213ES0131X	Foot Surgery Podiatrist	E4858	CA
9	213ES0103X	Foot & Ankle Surgery Podiatrist	POD001531	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA126338	OTHER	CA	MEDICARE PTAN NO CAL
3	CB217729	OTHER	CA	MEDICARE PTAN SO CAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306003850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ANN MONACO D.P.M.

Provider Business Mailing Address
First Line	:	1975 HIGHWAY 54 W STE 205
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4794
Country	:	US
Telephone Number	:	770-716-8732
Fax Number	:	770-487-1204

Provider Business Practice Location Address
First Line	:	3910 ROSEMONT DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5626
Country	:	US
Telephone Number	:	762-985-0020
Fax Number	:	762-985-0018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	11/14/2022

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Directions to “ DR. JENNIFER ANN MONACO D.P.M.” Practice Location

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