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General NPI Number Information
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NPI Number | 1265671911
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Entity Type | Organization
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Legal Business Name | M & J THERAPEUTIC SERVICES INC.
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 1011 BRUSHY FORK DR
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City | GREENSBORO
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State | NC
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Zip | 27406-8061
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Country | US
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Telephone | 336-987-2389
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 BRUSHY FORK DR
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City | GREENSBORO
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State | NC
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Zip | 27406-8061
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Country | US
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Telephone | 336-987-2389
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Fax |
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | MR. DEREK EDWARD MORGAN I
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Credential | B.S., QMHP
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Telephone | 336-987-2389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | NC
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