Provider Demographics
NPI:1326647116
Name:JOSLIN, ANGELA TRAVIS
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:TRAVIS
Last Name:JOSLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 PRESIDENTIAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206
Mailing Address - Country:US
Mailing Address - Phone:478-405-3915
Mailing Address - Fax:478-405-3918
Practice Address - Street 1:4628 PRESIDENTIAL PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-8708
Practice Address - Country:US
Practice Address - Phone:478-405-3915
Practice Address - Fax:478-405-3918
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA163531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist