Provider Demographics
NPI:1336189414
Name:HIGGINS, JOEL EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:EDWARD
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:903-934-5320
Mailing Address - Fax:903-934-5321
Practice Address - Street 1:450 NORTHSIDE CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8015
Practice Address - Country:US
Practice Address - Phone:404-303-1224
Practice Address - Fax:404-303-1325
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL#1399207V00000X
OH35C.001300207V00000X
TXP8480207V00000X
GA042055207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3569OtherOPT-OUT
GA11D0984976OtherCLIA
GA300034164AMedicaid
GA000858107CMedicaid