Provider Demographics
NPI:1245218361
Name:NOVAK, JOSEPH S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:NOVAK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:S
Other - Last Name:NOVAK
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:918 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6198
Mailing Address - Country:US
Mailing Address - Phone:229-226-8800
Mailing Address - Fax:229-226-8232
Practice Address - Street 1:918 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6198
Practice Address - Country:US
Practice Address - Phone:229-226-8800
Practice Address - Fax:229-226-8232
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046464174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000809113CMedicaid
GAG50997Medicare UPIN
GA202I167567Medicare PIN