Provider Demographics
NPI:1831494277
Name:MACEMORE, JOANIE BLEVINS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JOANIE
Middle Name:BLEVINS
Last Name:MACEMORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JOANIE
Other - Middle Name:BETH
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3721 FALL CREEK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-9166
Mailing Address - Country:US
Mailing Address - Phone:336-957-0029
Mailing Address - Fax:
Practice Address - Street 1:180 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2430
Practice Address - Country:US
Practice Address - Phone:336-527-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant