Basic Information
| Provider Information | |||||||||
| NPI: | 1093819799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WADE-HAMME | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | DEANETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2506 LAKELAND DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392327640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013262599 | ||||||||
| FaxNumber: | 6019330852 | ||||||||
| Practice Location | |||||||||
| Address1: | 2506 LAKELAND DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392327640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013262599 | ||||||||
| FaxNumber: | 6019330852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 16754 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 16754 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 00122170 | 05 | MS | MEDICAID | 0122170 | 05 | MS | MEDICAID |