Basic Information
| Provider Information | |||||||||
| NPI: | 1124412796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIANNONI | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ED.D, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 TERRELL MILL RD SE BLDG 1460-205 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300671408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044399981 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1355 TERRELL MILL RD SE BLDG 1460-205 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300671408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044399981 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2015 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | APC004395 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.