Provider Demographics
NPI:1487760575
Name:WHITLATCH, JOSEPH WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:WHITLATCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2323 PIEDMONT RD NE APT 2408
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3438
Mailing Address - Country:US
Mailing Address - Phone:651-792-6329
Mailing Address - Fax:
Practice Address - Street 1:1245 CUMBERLAND MALL SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3136
Practice Address - Country:US
Practice Address - Phone:704-345-4607
Practice Address - Fax:770-434-5460
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist