Provider Demographics
NPI:1003176082
Name:MCCARTHY, JOLI ANN (DO)
Entity Type:Individual
Prefix:MRS
First Name:JOLI
Middle Name:ANN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:JOLI
Other - Middle Name:ANN
Other - Last Name:MAMMELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1805 PARKE PLAZA CIR
Mailing Address - Street 2:STE 103
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087
Mailing Address - Country:US
Mailing Address - Phone:770-498-9355
Mailing Address - Fax:478-633-7354
Practice Address - Street 1:3950 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1121
Practice Address - Country:US
Practice Address - Phone:770-732-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72821208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics