Provider Demographics
NPI:1952396384
Name:FACCIA, GIOVANNI (MD)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:
Last Name:FACCIA
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 190
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-0190
Mailing Address - Country:US
Mailing Address - Phone:931-840-9588
Mailing Address - Fax:931-381-3519
Practice Address - Street 1:230 E JAMES M CAMPBELL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-0504
Practice Address - Country:US
Practice Address - Phone:931-840-9588
Practice Address - Fax:931-381-3519
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12669208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB04091Medicare UPIN
TN3802632Medicare ID - Type Unspecified