MEDICARE: BJUTIFUL SOUL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1922647874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BJUTIFUL SOUL

Provider Business Mailing Address
First Line	:	12830 ENGLISH WALNUT LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5027
Country	:	US
Telephone Number	:	704-961-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	8510 MCALPINE PARK DR STE 209
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-6250
Country	:	US
Telephone Number	:	980-494-0011
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KJUANA DIGGS
Credential	:
Telephone Number	:	704-961-8218

Provider Enumeration Date	:	12/24/2019
Last Update Date	:	12/24/2019

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Directions to “BJUTIFUL SOUL ” Practice Location

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