Provider Demographics
NPI:1871881920
Name:ADDO, JOYCE AMA (MSPAS)
Entity type:Individual
Prefix:MISS
First Name:JOYCE
Middle Name:AMA
Last Name:ADDO
Suffix:
Gender:F
Credentials:MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-1316
Mailing Address - Country:US
Mailing Address - Phone:731-588-0777
Mailing Address - Fax:731-588-0777
Practice Address - Street 1:1804 MAIN STREET
Practice Address - Street 2:RAINBOW PEDIATRIC
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343
Practice Address - Country:US
Practice Address - Phone:731-784-7833
Practice Address - Fax:731-784-7856
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPENDING363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical