Provider Demographics
NPI:1992223531
Name:MOORHEAD, JOEL (MD, MPH, PHD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MOORHEAD
Suffix:
Gender:M
Credentials:MD, MPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 EIDSON HALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5685
Mailing Address - Country:US
Mailing Address - Phone:404-274-1335
Mailing Address - Fax:
Practice Address - Street 1:1521 EIDSON HALL DRIVE
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:404-274-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA516922083C0008X, 208D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47917OtherUPIN