Provider Demographics
NPI:1902428584
Name:FEARS, JOYCE L
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:L
Last Name:FEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-2058
Mailing Address - Country:US
Mailing Address - Phone:770-957-5561
Mailing Address - Fax:678-792-4866
Practice Address - Street 1:227 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2058
Practice Address - Country:US
Practice Address - Phone:770-957-5561
Practice Address - Fax:678-792-4866
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist