Healthcare Provider Details

I. General information

NPI: 1528847761
Provider Name (Legal Business Name): DYNAMIC GROUP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SUNSET AVE STE B
ROCKY MOUNT NC
27804-5616
US

IV. Provider business mailing address

8911 ELIZABETH BENNET PL
RALEIGH NC
27616-9050
US

V. Phone/Fax

Practice location:
  • Phone: 919-673-8240
  • Fax:
Mailing address:
  • Phone: 252-258-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA BAZEMORE
Title or Position: PRESIDENT
Credential:
Phone: 252-258-5176