MEDICARE: DR. JOSEPH WILLIAM WHITLATCH OD

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
1	152W00000X	Optometrist	OPT002559	GA

General Provider Information

NPI Number	:	1487760575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WILLIAM WHITLATCH OD

Provider Business Mailing Address
First Line	:	2323 PIEDMONT RD NE APT 2408
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3438
Country	:	US
Telephone Number	:	651-792-6329
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 CUMBERLAND MALL SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3136
Country	:	US
Telephone Number	:	704-345-4607
Fax Number	:	770-434-5460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	11/21/2019

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