Provider Demographics
NPI:1033083613
Name:RINCON, JAVIER S SR
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:S
Last Name:RINCON
Suffix:SR
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 1:205 WESTCHESTER DR APT 21
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2050
Mailing Address - Country:US
Mailing Address - Phone:706-540-7848
Mailing Address - Fax:706-540-6147
Practice Address - Street 1:205 WESTCHESTER DR APT 21
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2050
Practice Address - Country:US
Practice Address - Phone:706-540-7848
Practice Address - Fax:706-540-6147
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20240917142142246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty