Provider Demographics
NPI:1083613665
Name:BIRD, JOSEPH MELTON (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MELTON
Last Name:BIRD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 EAST HOSPITAL ROAD
Mailing Address - Street 2:ROOM 13A-10
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-6377
Mailing Address - Fax:706-787-1458
Practice Address - Street 1:300 EAST HOSPITAL ROAD
Practice Address - Street 2:ROOM 13A-10
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-6377
Practice Address - Fax:706-787-1458
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900010451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical