Provider Demographics
NPI:1831537877
Name:GIOVINCO, NICHOLAS ANTHONY (DPM)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:GIOVINCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HWY 54 W.
Mailing Address - Street 2:STE 205
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:770-487-1232
Practice Address - Street 1:1975 HWY 54 W.
Practice Address - Street 2:STE 200
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4794
Practice Address - Country:US
Practice Address - Phone:770-487-6716
Practice Address - Fax:770-487-7721
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001196213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery