Healthcare Provider Details

I. General information

NPI: 1255480836
Provider Name (Legal Business Name): ST. JOSEPH CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W WAUGH ST
DALTON GA
30720-8769
US

IV. Provider business mailing address

1102 W WAUGH ST
DALTON GA
30720-8769
US

V. Phone/Fax

Practice location:
  • Phone: 706-277-2321
  • Fax: 706-226-1492
Mailing address:
  • Phone: 706-277-2321
  • Fax: 706-226-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PABLO E PEREZ
Title or Position: CEO
Credential: M.D.
Phone: 706-277-2321