Provider Demographics
NPI:1962449744
Name:CHOVANEC, JOSEPH P (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:CHOVANEC
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 932925
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2925
Mailing Address - Country:US
Mailing Address - Phone:800-364-9216
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:303 PARKWAY DRIVE, N.E.
Practice Address - Street 2:PMB 404
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1212
Practice Address - Country:US
Practice Address - Phone:404-265-4421
Practice Address - Fax:404-265-3894
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000333367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000158GMedicaid
GA1962449744OtherNPI
GA100000158BMedicaid
GAN341470OtherWELLCARE MEDICAID
GA1982637419OtherGROUP NPI
GAP00158088OtherRAILROAD MEDICARE
GAN341470OtherWELLCARE MEDICAID
GAP00158088OtherRAILROAD MEDICARE
GAN341470OtherWELLCARE MEDICAID