Provider Demographics
NPI:1285973677
Name:JOYCE, JULISSA GRACE (MD)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:GRACE
Last Name:JOYCE
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 OLIN WAY
Practice Address - Street 2:STE 2300
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9243
Practice Address - Country:US
Practice Address - Phone:704-801-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01996208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1285973677Medicaid
SCNC2915Medicaid