Basic Information
Provider Information | |||||||||
NPI: | 1801161252 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JOSEPH | ||||||||
FirstName: | NAIMA | ||||||||
MiddleName: | THAVORY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 34 HANCOCK ST | ||||||||
Address2: | APT 1C | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021144163 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5743691904 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 690 DALLAS HWY STE 301 | ||||||||
Address2: |   | ||||||||
City: | VILLA RICA | ||||||||
State: | GA | ||||||||
PostalCode: | 301801262 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7708123850 | ||||||||
FaxNumber: | 7708123623 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/19/2012 | ||||||||
LastUpdateDate: | 06/07/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207V00000X | 251880 | MA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.