Provider Demographics
NPI:1639376759
Name:DEIRDRE Z JOINER NICHOLS MD LLC
Entity type:Organization
Organization Name:DEIRDRE Z JOINER NICHOLS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JOINER-NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:257-772-0606
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-0147
Mailing Address - Country:US
Mailing Address - Phone:256-772-0606
Mailing Address - Fax:
Practice Address - Street 1:105 W DUBLIN DR.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1787
Practice Address - Country:US
Practice Address - Phone:256-772-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98325Medicare UPIN