Provider Demographics
NPI:1598105140
Name:HEAD, JUSTIN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:HEAD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1706 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9481
Mailing Address - Country:US
Mailing Address - Phone:803-293-1160
Mailing Address - Fax:803-293-1130
Practice Address - Street 1:6950 E CHAUNCEY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054
Practice Address - Country:US
Practice Address - Phone:623-873-8565
Practice Address - Fax:480-372-2110
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2019-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101020756207X00000X
GA82997207X00000X
SCDO82118207X00000X
AZ007594207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery