Provider Demographics
NPI:1053831230
Name:RICCI, ALFRED GIANNI (DO)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:GIANNI
Last Name:RICCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:GIANNI
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:706-494-3071
Mailing Address - Fax:
Practice Address - Street 1:2257 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7790
Practice Address - Country:US
Practice Address - Phone:334-245-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83955207XX0004X
390200000X
ALDO2085207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program