Provider Demographics
NPI:1245344027
Name:JOSEPH, GEORGE MICHEAL JR (MS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MICHEAL
Last Name:JOSEPH
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 THE GREENS WAY
Mailing Address - Street 2:SUITE 18
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1417
Mailing Address - Country:US
Mailing Address - Phone:904-280-3552
Mailing Address - Fax:
Practice Address - Street 1:1579 THE GREENS WAY
Practice Address - Street 2:SUITE 18
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-1417
Practice Address - Country:US
Practice Address - Phone:904-280-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16971Medicare ID - Type Unspecified