Healthcare Provider Details

I. General information

NPI: 1164143517
Provider Name (Legal Business Name): JOE MONTES DE OCA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 ALPHARETTA HWY STE 100
ROSWELL GA
30076-3805
US

IV. Provider business mailing address

11650 ALPHARETTA HWY STE 100
ROSWELL GA
30076-3805
US

V. Phone/Fax

Practice location:
  • Phone: 404-596-5670
  • Fax: 404-334-0479
Mailing address:
  • Phone: 404-596-5670
  • Fax: 404-334-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN302741
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN302741
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: