MEDICARE: THOMAS JOSEPH MEZZANOTTE MD

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	207XX0801X	Orthopaedic Trauma Physician	ME99006	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA29228552	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000245847	OTHER	SC	UNISON
3	055	OTHER	SC	BCBS
4	013	OTHER	SC	TRICARE
5	1774374	OTHER	SC	CIGNA
6	210718	OTHER	SC	MEDCOST
7	9975193	OTHER	SC	AETNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	20078496	OTHER	SC	SELECT HEALTH
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609841931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOSEPH MEZZANOTTE MD

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0370
Country	:	US
Telephone Number	:	706-494-3171
Fax Number	:	706-221-3132

Provider Business Practice Location Address
First Line	:	819 E OAK ST STE A
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-5842
Country	:	US
Telephone Number	:	407-476-0780
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	01/12/2026

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Directions to “ THOMAS JOSEPH MEZZANOTTE MD” Practice Location

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