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NPI Code Detail

MEDICARE: ST. JOSEPH CLINIC, P.C.

MEDICARE: ST. JOSEPH CLINIC, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician
2207RE0101XEndocrinology, Diabetes & Metabolism Physician
3207R00000XInternal Medicine Physician
42084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1255480836
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOSEPH CLINIC, P.C.
Provider Business Mailing Address
First Line : 1102 W WAUGH ST
Second Line :
City : DALTON
State : GA
Zip : 30720-8769
Country : US
Telephone Number : 706-277-2321
Fax Number : 706-226-1492
Provider Business Practice Location Address
First Line : 1102 W WAUGH ST
Second Line :
City : DALTON
State : GA
Zip : 30720-8769
Country : US
Telephone Number : 706-277-2321
Fax Number : 706-226-1492
Authorized Official
Title or Position : CEO
Name : DR. PABLO E PEREZ
Credential : M.D.
Telephone Number : 706-277-2321
Provider Enumeration Date : 01/10/2007
Last Update Date : 04/07/2026

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