Provider Demographics
NPI:1528014537
Name:JOINES, JERRY DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DALE
Last Name:JOINES
Suffix:
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 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-3948
Mailing Address - Fax:336-832-8641
Practice Address - Street 1:1200 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1004
Practice Address - Country:US
Practice Address - Phone:336-832-8062
Practice Address - Fax:336-832-8641
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC51447OtherMEDCOST
NC7185OtherPARTNERS MEDICARE CHOICE
NC8946731Medicaid
NC1170AOtherBCBS NC
NC7394252OtherAETNA
NC2161620AMedicare ID - Type UnspecifiedMEDICARE
NC51447OtherMEDCOST