Provider Demographics
NPI:1255331765
Name:JOINER-NICHOLS, DEIRDRE Z (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:Z
Last Name:JOINER-NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 CEDARBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9028
Mailing Address - Country:US
Mailing Address - Phone:256-508-7370
Mailing Address - Fax:
Practice Address - Street 1:3276 BUFORD DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-5702
Practice Address - Country:US
Practice Address - Phone:404-251-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH98325Medicare UPIN
AL051518897Medicare ID - Type Unspecified