Healthcare Provider Details

I. General information

NPI: 1164429676
Provider Name (Legal Business Name): JOSEPH A. ST. LOUIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD NE SUITE 400
ATLANTA GA
30342-5000
US

IV. Provider business mailing address

5901 PEACHTREE DUNWOODY RD NE SUITE C-370
ATLANTA GA
30328-5382
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-1507
  • Fax: 404-256-1981
Mailing address:
  • Phone: 678-892-2020
  • Fax: 678-538-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number010675
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: