Provider Demographics
NPI:1659609808
Name:DATA, JOANN L (MD,PHD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:L
Last Name:DATA
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 PIN HOOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-4460
Mailing Address - Country:US
Mailing Address - Phone:931-761-2918
Mailing Address - Fax:931-761-2918
Practice Address - Street 1:777 PIN HOOK RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-4460
Practice Address - Country:US
Practice Address - Phone:931-761-2918
Practice Address - Fax:931-761-2918
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000008104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine