Provider Demographics
NPI:1396062055
Name:DOBBECK, JOANNA WARD (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:WARD
Last Name:DOBBECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6602 ABERCORN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5849
Mailing Address - Country:US
Mailing Address - Phone:980-352-7546
Mailing Address - Fax:
Practice Address - Street 1:6602 ABERCORN ST STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:980-352-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002292363AS0400X
GA008004363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCF309AMedicare PIN