Provider Demographics
NPI:1386917425
Name:JOSEPH L. MICCA, MD
Entity type:Organization
Organization Name:JOSEPH L. MICCA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-888-2524
Mailing Address - Street 1:PO BOX 3253
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30023-3253
Mailing Address - Country:US
Mailing Address - Phone:770-888-2524
Mailing Address - Fax:770-888-2510
Practice Address - Street 1:1938 RAND RIDGE CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5340
Practice Address - Country:US
Practice Address - Phone:770-596-7328
Practice Address - Fax:770-809-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39179207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty