Provider Demographics
NPI:1215044813
Name:ALEXANDER, JOE MCKNITT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:MCKNITT
Last Name:ALEXANDER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PILOT AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303
Mailing Address - Country:US
Mailing Address - Phone:910-483-5618
Mailing Address - Fax:
Practice Address - Street 1:2911 BREEZEWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-483-1811
Practice Address - Fax:910-483-6990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33605170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891251AMedicaid
NC6902348Medicaid
NC6902348Medicaid
NC2280277Medicare ID - Type Unspecified