Provider Demographics
NPI:1053478511
Name:GROFT, JOEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:THOMAS
Last Name:GROFT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 PRINCE AVE
Mailing Address - Street 2:STE 184 N
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5805
Mailing Address - Country:US
Mailing Address - Phone:706-227-3292
Mailing Address - Fax:706-355-3000
Practice Address - Street 1:1010 PRINCE AVE
Practice Address - Street 2:STE 184 N
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5805
Practice Address - Country:US
Practice Address - Phone:706-227-3292
Practice Address - Fax:706-355-3000
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV00118Medicare UPIN
GA35ZCHSHMedicare ID - Type UnspecifiedMEDICARE B