Healthcare Provider Details

I. General information

NPI: 1346663192
Provider Name (Legal Business Name): JOSEPH NATHANIEL INGLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

2142 W BROAD ST BLDG 100, STE 200
ATHENS GA
30606-3506
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5076
  • Fax:
Mailing address:
  • Phone: 706-548-6881
  • Fax: 706-546-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: