Healthcare Provider Details

I. General information

NPI: 1356468995
Provider Name (Legal Business Name): MDG MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 NEWTON ST
GREENSBORO NC
27406-5516
US

IV. Provider business mailing address

PO BOX 5522
GREENSBORO NC
27435-0522
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-7656
  • Fax: 336-294-4791
Mailing address:
  • Phone: 336-294-7656
  • Fax: 336-294-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberHC1601
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHC1601
License Number StateNC

VIII. Authorized Official

Name: MR. JEROME RASHAWN FOX II
Title or Position: CEO
Credential:
Phone: 336-294-7656