Individual
JOSEPH L MICCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1938 RAND RIDGE CT, MARIETTA, GA 30062-5340
(770) 888-2524
Mailing address
1938 RAND RIDGE CT, MARIETTA, GA 30062-5340
(770) 888-2524
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
39179
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00646929C
—
GA
01
—
110140782
MEDICARE RAILROAD
GA
Enumeration date
08/31/2006
Last updated
07/02/2008
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