Provider Demographics
NPI:1316707318
Name:JOSEPH, ANDREA FARAH (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:FARAH
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2433 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1414
Mailing Address - Country:US
Mailing Address - Phone:404-944-2142
Mailing Address - Fax:
Practice Address - Street 1:601 S 8TH ST, GRIFFIN, GA 30224
Practice Address - Street 2:601 S 8TH STREET
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-228-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA12297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant