Provider Demographics
NPI:1568442952
Name:PALIN, JOSEPH STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:PALIN
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 1:214 E WARD ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3114
Mailing Address - Country:US
Mailing Address - Phone:770-836-1011
Mailing Address - Fax:770-836-1049
Practice Address - Street 1:214 E WARD ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3114
Practice Address - Country:US
Practice Address - Phone:770-836-1011
Practice Address - Fax:770-836-1049
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025006207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000264756AMedicaid
GA000264756AMedicaid
GA202I105196Medicare PIN