Provider Demographics
NPI:1144849134
Name:JOYCE, CARL JR (LMT)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:JOYCE
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3678 MORNINGSIDE VILLAGE LN APT E
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-5565
Mailing Address - Country:US
Mailing Address - Phone:404-966-6972
Mailing Address - Fax:
Practice Address - Street 1:3678 MORNINGSIDE VILLAGE LN APT E
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-5565
Practice Address - Country:US
Practice Address - Phone:404-966-6972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009455225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist