MEDICARE: MRS. JOY STEPHANIE DAISE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	8967	GA

General Provider Information

NPI Number	:	1154303451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOY STEPHANIE DAISE PA-C

Provider Business Mailing Address
First Line	:	141 HENRY PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6636
Country	:	US
Telephone Number	:	770-288-7692
Fax Number	:	770-288-7690

Provider Business Practice Location Address
First Line	:	141 HENRY PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6636
Country	:	US
Telephone Number	:	770-288-7692
Fax Number	:	770-288-7690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	02/07/2023

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