Basic Information
Provider Information
NPI: 1205157799
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOYNER
FirstName: ADRIENNE
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: D.P.M.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1056 E RAINES RD
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381166337
CountryCode: US
TelephoneNumber: 9013005777
FaxNumber: 9014226092
Practice Location
Address1: 1056 E RAINES RD
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381166337
CountryCode: US
TelephoneNumber: 9013005777
FaxNumber: 9014226092
Other Information
ProviderEnumerationDate: 06/18/2010
LastUpdateDate: 10/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103XSC006238PAN Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
213ES0103X733TNY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


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