Provider Demographics
NPI:1124111257
Name:PRICE, JOEY S (MD)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:S
Last Name:PRICE
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 1172
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1172
Mailing Address - Country:US
Mailing Address - Phone:615-449-5771
Mailing Address - Fax:
Practice Address - Street 1:107 GLIDEPATH WAY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4133
Practice Address - Country:US
Practice Address - Phone:615-449-5771
Practice Address - Fax:615-449-5740
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29676207ND0101X
FLME91401207ND0101X
TN42459207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4800Medicare ID - Type UnspecifiedGROUP ID
FLAA530ZMedicare ID - Type UnspecifiedPPIN
FLI67767Medicare UPIN