Individual
JOYCE B. DEMESTIHAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 KNIGHT RD, MARIETTA, GA 30066-4424
(678) 644-5288
Mailing address
3550 KNIGHT RD, MARIETTA, GA 30066-4424
(678) 644-5288
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004352
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10034428
AMERIGROUP
GA
01
—
249332394A
PEACH STATE HEALTH PLAN
GA
05
—
249332394A
—
GA
01
—
312512
WELLCARE
GA
Enumeration date
12/14/2006
Last updated
07/08/2007
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