Provider Demographics
NPI:1518504083
Name:DOSS, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:DOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MIZE ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-3346
Mailing Address - Country:US
Mailing Address - Phone:423-991-0034
Mailing Address - Fax:
Practice Address - Street 1:393 MURPHY LN
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5654
Practice Address - Country:US
Practice Address - Phone:423-991-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health