Provider Demographics
NPI:1770753311
Name:GEORGE M JOSEPH MD PA
Entity type:Organization
Organization Name:GEORGE M JOSEPH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-280-3552
Mailing Address - Street 1:2370 3RD ST S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4023
Mailing Address - Country:US
Mailing Address - Phone:904-280-3552
Mailing Address - Fax:904-280-3571
Practice Address - Street 1:2370 3RD ST S
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4023
Practice Address - Country:US
Practice Address - Phone:904-280-3552
Practice Address - Fax:904-280-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 151752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ865Medicare PIN