Provider Demographics
NPI:1508857038
Name:CERAVOLO, JOSEPH FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANK
Last Name:CERAVOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1240 BROOKSTONE CENTRE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2988
Mailing Address - Country:US
Mailing Address - Phone:706-323-8127
Mailing Address - Fax:706-596-4837
Practice Address - Street 1:1240 BROOKSTONE CENTRE PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2988
Practice Address - Country:US
Practice Address - Phone:706-323-8127
Practice Address - Fax:706-596-4837
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 052155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBCBSOtherMONTGOMERY SURGERY CENTER
GA00979349AMedicaid
GA00979349AMedicaid
GAF22089Medicare UPIN