Provider Demographics
NPI:1306860143
Name:HAIR, JOE F JR (DMD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:F
Last Name:HAIR
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6842 DOUGLAS BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1576
Mailing Address - Country:US
Mailing Address - Phone:770-949-1005
Mailing Address - Fax:
Practice Address - Street 1:6842 DOUGLAS BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1576
Practice Address - Country:US
Practice Address - Phone:770-949-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0096361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000919311CMedicaid
GA000919311BMedicaid