1669038303 NPI number — MRS. MONIQUE ANTOINETTE JOSEPH FNP

Table of content: MRS. MONIQUE ANTOINETTE JOSEPH FNP (NPI 1669038303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669038303 NPI number — MRS. MONIQUE ANTOINETTE JOSEPH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPH
Provider First Name:
MONIQUE
Provider Middle Name:
ANTOINETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAULK
Provider Other First Name:
MONIQUE
Provider Other Middle Name:
ANTOINETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669038303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3012 NORWELL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCUST GROVE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30248-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-245-5516
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3334 HIGHWAY 155 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCUST GROVE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-305-7929
Provider Business Practice Location Address Fax Number:
770-305-7969
Provider Enumeration Date:
05/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN170750 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN170750 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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