Provider Demographics
NPI:1750443891
Name:DEMESTIHAS, JOYCE B
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:B
Last Name:DEMESTIHAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:BETH
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3550 KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4424
Mailing Address - Country:US
Mailing Address - Phone:678-644-5288
Mailing Address - Fax:
Practice Address - Street 1:3550 KNIGHT RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4424
Practice Address - Country:US
Practice Address - Phone:678-644-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA249332394AOtherPEACH STATE HEALTH PLAN
GA10034428OtherAMERIGROUP
GA249332394AMedicaid
GA312512OtherWELLCARE