Provider Demographics
NPI:1124412796
Name:GIANNONI, TIMOTHY (EDD, MS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:GIANNONI
Suffix:
Gender:M
Credentials:EDD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 TERRELL MILL RD SE BLDG 1460-205
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-1408
Mailing Address - Country:US
Mailing Address - Phone:404-439-9981
Mailing Address - Fax:
Practice Address - Street 1:1355 TERRELL MILL RD SE BLDG 1460-205
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1408
Practice Address - Country:US
Practice Address - Phone:404-439-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health