Provider Demographics
NPI:1134146780
Name:PERLOW, JOAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:S
Last Name:PERLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 465117
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-5117
Mailing Address - Country:US
Mailing Address - Phone:770-688-3804
Mailing Address - Fax:770-237-6148
Practice Address - Street 1:2540 WINDY HILL RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8605
Practice Address - Country:US
Practice Address - Phone:770-688-3804
Practice Address - Fax:770-237-6148
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0248542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000336047HMedicaid
GA000336047IMedicaid
GA00336047AMedicaid
GAE99796Medicare UPIN
GA000336047HMedicaid
GA30CDBLAMedicare PIN