Provider Demographics
NPI:1487615456
Name:HEAD, JOSEPH A (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:HEAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-652-7776
Mailing Address - Fax:828-652-7807
Practice Address - Street 1:1633 SUGAR HILL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5239
Practice Address - Country:US
Practice Address - Phone:828-652-7776
Practice Address - Fax:828-652-7807
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102114207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970026952OtherRAILROAD RETIREMENT
NCS47516Medicare UPIN
NC2746553Medicare PIN