Provider Demographics
NPI:1306003850
Name:MONACO, JENNIFER ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:MONACO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:D'AMICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:770-716-8732
Mailing Address - Fax:770-487-1204
Practice Address - Street 1:3910 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5626
Practice Address - Country:US
Practice Address - Phone:762-985-0020
Practice Address - Fax:762-985-0018
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT962213E00000X, 213EP1101X, 213ES0103X
CAE4858213E00000X, 213EP1101X, 213ES0000X, 213ES0103X, 213ES0131X
GAPOD001531213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008073203Medicaid
CACA126338OtherMEDICARE PTAN NO CAL
CACB217729OtherMEDICARE PTAN SO CAL