Provider Demographics
NPI:1982625158
Name:JOELSON, DEAN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:WILLIAM
Last Name:JOELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 491028
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049
Mailing Address - Country:US
Mailing Address - Phone:404-605-3247
Mailing Address - Fax:404-609-6645
Practice Address - Street 1:1968 PEACHTREE ROAD NW
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-605-3247
Practice Address - Fax:404-609-6645
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057662207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00339599Medicare PIN
GA22BDDWSMedicare PIN