Provider Demographics
NPI:1396522348
Name:TABOIS, GIANNI
Entity type:Individual
Prefix:
First Name:GIANNI
Middle Name:
Last Name:TABOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 GLEN RD NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1402
Mailing Address - Country:US
Mailing Address - Phone:770-870-4195
Mailing Address - Fax:
Practice Address - Street 1:1620 SUGARMAPLE LN SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6282
Practice Address - Country:US
Practice Address - Phone:770-870-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care