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NPI Code Detail

MEDICARE: DR. JOEL ALAN AHLGRIM D.O.

MEDICARE: DR. JOEL ALAN AHLGRIM D.O.
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
1207Q00000XFamily Medicine PhysicianOS20124FL

General Provider Information

NPI Number : 1306821236
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOEL ALAN AHLGRIM D.O.
Provider Business Mailing Address
First Line : PO BOX 746638
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6638
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 400 COLONNADE DR STE 230
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-6237
Country : US
Telephone Number : 904-376-3970
Fax Number : 904-376-3435
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 05/14/2025

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