Healthcare Provider Details

I. General information

NPI: 1770400400
Provider Name (Legal Business Name): CMGM ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE S
HENRICO VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR STE S
HENRICO VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 804-905-4650
  • Fax:
Mailing address:
  • Phone: 804-905-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MARLON MEREDITH
Title or Position: OWNER
Credential:
Phone: 307-752-9490