Provider Demographics
NPI:1477658136
Name:GASKINS, JOE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:EDWARD
Last Name:GASKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 GREAT OAKS DR A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8211
Mailing Address - Country:US
Mailing Address - Phone:770-267-8368
Mailing Address - Fax:770-207-0640
Practice Address - Street 1:513 GREAT OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8211
Practice Address - Country:US
Practice Address - Phone:770-267-8368
Practice Address - Fax:770-207-0640
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033967173000000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000542286BMedicaid
GA52431027OtherBC/BS
GAF63961Medicare UPIN
GA000542286BMedicaid