Provider Demographics
NPI:1619647419
Name:MCCARTY, GEOVANIE ALCIDES
Entity Type:Individual
Prefix:
First Name:GEOVANIE
Middle Name:ALCIDES
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 40TH ST S APT 220
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4484
Mailing Address - Country:US
Mailing Address - Phone:786-559-8401
Mailing Address - Fax:
Practice Address - Street 1:1750 40TH ST S APT 220
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4484
Practice Address - Country:US
Practice Address - Phone:786-559-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant