Provider Demographics
NPI:1538247556
Name:ZELLER, JOAN H (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:H
Last Name:ZELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:109 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3862
Practice Address - Country:US
Practice Address - Phone:770-834-0170
Practice Address - Fax:770-214-1546
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47043207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581456616OtherTAX ID
GA333750OtherWELLCARE
GA52728648001OtherBLUE CROSS BLUE SHIELD
GA000824051AOtherPEACH STATE
GA00824051AMedicaid
GA333750OtherWELLCARE
GA52728648001OtherBLUE CROSS BLUE SHIELD
GA16BDSVXMedicare ID - Type Unspecified