Healthcare Provider Details

I. General information

NPI: 1245644350
Provider Name (Legal Business Name): CARRIE M JOSEPH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE M LEISTNER OD

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MARKET PLACE BLVD
CARTERSVILLE GA
30121-2235
US

IV. Provider business mailing address

239 MARKET PLACE BLVD
CARTERSVILLE GA
30121-2235
US

V. Phone/Fax

Practice location:
  • Phone: 770-607-1449
  • Fax:
Mailing address:
  • Phone: 770-607-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008166
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: