Provider Demographics
NPI:1255371670
Name:GAMMONS, JOANNA (DO)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:GAMMONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1835
Mailing Address - Country:US
Mailing Address - Phone:248-548-7707
Mailing Address - Fax:248-548-7736
Practice Address - Street 1:713 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1835
Practice Address - Country:US
Practice Address - Phone:248-548-7707
Practice Address - Fax:248-548-7736
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG014835207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology