Provider Demographics
NPI:1154303451
Name:DAISE, JOY STEPHANIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:STEPHANIE
Last Name:DAISE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HENRY PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6636
Mailing Address - Country:US
Mailing Address - Phone:770-288-7692
Mailing Address - Fax:770-288-7690
Practice Address - Street 1:141 HENRY PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6636
Practice Address - Country:US
Practice Address - Phone:770-288-7692
Practice Address - Fax:770-288-7690
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8967363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDAPA22261Medicare ID - Type Unspecified