Healthcare Provider Details

I. General information

NPI: 1134146780
Provider Name (Legal Business Name): JOAN S. PERLOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WINDY HILL RD SE
MARIETTA GA
30067-8605
US

IV. Provider business mailing address

P.O. BOX 465117
LAWRENCEVILLE GA
30042-5117
US

V. Phone/Fax

Practice location:
  • Phone: 770-688-3804
  • Fax: 770-237-6148
Mailing address:
  • Phone: 770-688-3804
  • Fax: 770-237-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number024854
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: