Individual
JOHN MICHAEL DEMICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11700 MERCY BLVD, PLAZA D SUITE A-1, SAVANNAH, GA 31419-1753
(912) 920-8898
(912) 920-4418
Mailing address
11700 MERCY BLVD, PLAZA D SUITE A-1, SAVANNAH, GA 31419-1753
(912) 920-8898
(912) 920-4418
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
016855
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000586539C
—
GA
01
—
145002
BLUECROSS BLUESHIELD
GA
05
—
G16855
—
SC
Enumeration date
07/13/2005
Last updated
07/14/2010
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