Provider Demographics
NPI:1346359296
Name:OVERTON, JOSEPH T JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:OVERTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 945934
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5934
Mailing Address - Country:US
Mailing Address - Phone:770-788-0620
Mailing Address - Fax:678-342-3327
Practice Address - Street 1:4155 BAKER ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1405
Practice Address - Country:US
Practice Address - Phone:770-788-0620
Practice Address - Fax:678-342-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA038900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA77159135OtherWAUSAU PROVIDER #
GAGA0100OtherJOHN DEER NONPAR PROV #
GA953055OtherBC/BS PROVIDER #
GA00762308DMedicaid
GA1024502OtherAETNA HMO PROVIDER #
GA5261485OtherAETNA PPO PROVIDER #
GA0300335OtherEVERCARE PROVIDER #
GA4697OtherKAISER
GA4697OtherKAISER
GA5261485OtherAETNA PPO PROVIDER #
GAGA0100OtherJOHN DEER NONPAR PROV #