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NPI Code Detail

MEDICARE: JEFFREY JOHN KOVACIC MD

MEDICARE: JEFFREY JOHN KOVACIC 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
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician053836GA

General Provider Information

NPI Number : 1831164524
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY JOHN KOVACIC MD
Provider Business Mailing Address
First Line : PO BOX 12938
Second Line : C/O CLINIC MANAGEMENT
City : CALHOUN
State : GA
Zip : 30703-7066
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 400 TIMMS RD NE
Second Line :
City : CALHOUN
State : GA
Zip : 30701-7016
Country : US
Telephone Number : 706-602-3100
Fax Number : 706-602-3101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 07/29/2020

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