Provider Demographics
NPI:1457315434
Name:PALAZZOLO, JAMES VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:VINCENT
Last Name:PALAZZOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72105
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2105
Mailing Address - Country:US
Mailing Address - Phone:229-438-5864
Mailing Address - Fax:229-438-1004
Practice Address - Street 1:521 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1917
Practice Address - Country:US
Practice Address - Phone:229-438-5864
Practice Address - Fax:229-439-4769
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037637207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA479773OtherBCBS
GA5249773OtherSTATE MERIT
GAGA0064264OtherCHAMPUS
GA5249773OtherSTATE MERIT
GAGA0064264OtherCHAMPUS
GA81BBBBGMedicare ID - Type UnspecifiedCAHABA MEDICARE NUMBER