Basic Information
| Provider Information | |||||||||
| NPI: | 1336189414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGGINS | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5780 PEACHTREE DUNWOODY RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039345320 | ||||||||
| FaxNumber: | 9039345321 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 NORTHSIDE CHEROKEE BLVD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301158015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043031224 | ||||||||
| FaxNumber: | 4043031325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 03/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | P8480 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | TL#1399 | WY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 042055 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000858107C | 05 | GA | MEDICAID | 300034164A | 05 | GA | MEDICAID | GRP3569 | 01 | GA | OPT-OUT | OTHER | 11D0984976 | 01 | GA | CLIA | OTHER |