Provider Demographics
NPI:1962490292
Name:MIDDLEBROOKS, JOYCE L (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:L
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JOYCE
Other - Middle Name:H
Other - Last Name:MIDDLEBROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:70 WESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-6479
Mailing Address - Country:US
Mailing Address - Phone:770-832-7827
Mailing Address - Fax:770-830-0990
Practice Address - Street 1:105 PARK PLACE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-1960
Practice Address - Country:US
Practice Address - Phone:770-832-1494
Practice Address - Fax:770-830-0990
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN029107367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00550701KMedicaid
GA430071934OtherRRM PALMETO
GA00050701JMedicaid
GA000550701LMedicaid
GA000550701MMedicaid
GA214252OtherBIC
GA5822654OtherAETNA
GA214252OtherBIC
GA43ZCBXZ03Medicare ID - Type Unspecified