MEDICARE: DEIRDRE Z JOINER-NICHOLS M.D.

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	207Q00000X	Family Medicine Physician	78854	GA

General Provider Information

NPI Number	:	1255331765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE Z JOINER-NICHOLS M.D.

Provider Business Mailing Address
First Line	:	5304 CEDARBROOKE LN
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30518-9028
Country	:	US
Telephone Number	:	256-508-7370
Fax Number	:

Provider Business Practice Location Address
First Line	:	3276 BUFORD DR
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-5702
Country	:	US
Telephone Number	:	404-251-2890
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/21/2022

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