Provider Demographics
NPI:1487195764
Name:IVORY, JOANNIE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNIE
Middle Name:MICHELLE
Last Name:IVORY
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 1:5222 MANDEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-5149
Mailing Address - Country:US
Mailing Address - Phone:504-388-3123
Mailing Address - Fax:
Practice Address - Street 1:170 MANNING DRIVE 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-1004
Practice Address - Country:US
Practice Address - Phone:919-966-1996
Practice Address - Fax:910-966-6735
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125835988390200000X
NC261738390200000X
NC2021-03060207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program