Healthcare Provider Details

I. General information

NPI: 1811138126
Provider Name (Legal Business Name): YOSEF J. GILES SR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 WOODSTOCK RD
ROSWELL GA
30075-2141
US

IV. Provider business mailing address

1380 WOODSTOCK RD
ROSWELL GA
30075-2141
US

V. Phone/Fax

Practice location:
  • Phone: 770-640-3131
  • Fax:
Mailing address:
  • Phone: 770-640-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12856
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002854
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6012
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: