Basic Information
| Provider Information | |||||||||
| NPI: | 1851744007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIGIOVANNA | ||||||||
| FirstName: | MARCIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 925 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309030925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067748326 | ||||||||
| FaxNumber: | 7067747230 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 SAINT SEBASTIAN WAY STE 311 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067243473 | ||||||||
| FaxNumber: | 7067243493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2016 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | APRN.CNP.019494 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LG0600X | RN288572 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.