Provider Demographics
NPI:1215960513
Name:HOWARD, FONCO (DPM)
Entity type:Individual
Prefix:MR
First Name:FONCO
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12476 HOPEWELL RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1347
Mailing Address - Country:US
Mailing Address - Phone:770-452-9600
Mailing Address - Fax:770-452-8303
Practice Address - Street 1:2579 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3515
Practice Address - Country:US
Practice Address - Phone:770-452-9600
Practice Address - Fax:770-452-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000769213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000691347CMedicaid
GA000691347CMedicaid
GA48SCBTN01Medicare ID - Type UnspecifiedMEDICARE PROVIDER #