Provider Demographics
NPI:1831164524
Name:KOVACIC, JEFFREY JOHN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:KOVACIC
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 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-7066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 TIMMS RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7016
Practice Address - Country:US
Practice Address - Phone:706-602-3100
Practice Address - Fax:706-602-3101
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053836207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA152852716AMedicaid
20NCCLLMedicare ID - Type Unspecified
GA152852716AMedicaid