Provider Demographics
NPI:1871540542
Name:MEDINA, JOCELYN HAMILTON (MD)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:HAMILTON
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678948
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8948
Mailing Address - Country:US
Mailing Address - Phone:866-264-3435
Mailing Address - Fax:864-987-1611
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4601
Practice Address - Country:US
Practice Address - Phone:828-213-3524
Practice Address - Fax:864-987-1611
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN408482085R0202X
NC2560622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871540542Medicaid