Healthcare Provider Details

I. General information

NPI: 1093819799
Provider Name (Legal Business Name): JOYCE DEANETTE WADE-HAMME M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/16/2024
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 LAKELAND DR STE 300
FLOWOOD MS
39232-7640
US

IV. Provider business mailing address

2506 LAKELAND DR STE 300
FLOWOOD MS
39232-7640
US

V. Phone/Fax

Practice location:
  • Phone: 601-326-2599
  • Fax: 601-933-0852
Mailing address:
  • Phone: 601-326-2599
  • Fax: 601-933-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number16754
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16754
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: