Provider Demographics
NPI:1104022870
Name:JOSEPH, MAURICE (OD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 PEACHTREE DUNWOODY RD.
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1009
Mailing Address - Country:US
Mailing Address - Phone:770-351-8995
Mailing Address - Fax:770-688-1903
Practice Address - Street 1:6350 PEACHTREE DUNWOODY RD. NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1009
Practice Address - Country:US
Practice Address - Phone:770-351-8995
Practice Address - Fax:770-688-1903
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA821-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA821-TOtherLICENCE NUMBER