Healthcare Provider Details

I. General information

NPI: 1548708266
Provider Name (Legal Business Name): EG FAMILY PRACTICE AND PSYCHIATRY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11028 SPRING LAKE DR
BOWIE MD
20721-2924
US

IV. Provider business mailing address

PO BOX 4153
UPPER MARLBORO MD
20775-0153
US

V. Phone/Fax

Practice location:
  • Phone: 301-367-0564
  • Fax: 301-333-1909
Mailing address:
  • Phone: 301-367-0564
  • Fax: 301-333-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. GRACE O AKINPETIDE
Title or Position: MEDICAL DIRECTOR
Credential: PHD. DR OF NURSING
Phone: 301-367-0564