Provider Demographics
NPI:1932122769
Name:JOYNER, PAM (OT)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:JOYNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:KAY
Other - Last Name:DELOACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1325 E FORTIFICATION ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2442
Mailing Address - Country:US
Mailing Address - Phone:601-949-9110
Mailing Address - Fax:601-949-9113
Practice Address - Street 1:1325 E FORTIFICATION ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2442
Practice Address - Country:US
Practice Address - Phone:601-949-9110
Practice Address - Fax:601-949-9113
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS61OT0302081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04387857Medicaid
MS670000059Medicare PIN
MS04387857Medicaid