Provider Demographics
NPI:1346514221
Name:MINICH, JOSHUA (APRN, RN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MINICH
Suffix:
Gender:M
Credentials:APRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:GA
Mailing Address - Zip Code:31063-1902
Mailing Address - Country:US
Mailing Address - Phone:478-472-4633
Mailing Address - Fax:478-472-4637
Practice Address - Street 1:105 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:GA
Practice Address - Zip Code:31063-1902
Practice Address - Country:US
Practice Address - Phone:478-472-4633
Practice Address - Fax:478-472-4637
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2022-06-13
Deactivation Date:2020-07-24
Deactivation Code:
Reactivation Date:2021-01-13
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
GARN248941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101Y00000XBehavioral Health & Social Service ProvidersCounselor