Healthcare Provider Details

I. General information

NPI: 1285297143
Provider Name (Legal Business Name): JOYCE YUESHUO XU MD, DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YUESHUO XU

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE STE 2300
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE STE 2300
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5279
  • Fax: 404-778-5879
Mailing address:
  • Phone: 404-778-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number111473
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: