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General NPI Number Information
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NPI Number | 1316511017
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Entity Type | Organization
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Legal Business Name | AMETHYST TECHNOLOGIES LLC
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 7039 LIBERTY RD
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City | GWYNN OAK
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State | MD
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Zip | 21207-5802
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Country | US
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Telephone | 443-543-5576
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Fax | 443-543-5574
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Provider Business Mailing Address
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Address Line | 7039 LIBERTY RD
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City | GWYNN OAK
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State | MD
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Zip | 21207-5802
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Country | US
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Telephone | 240-463-3445
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY BROWN
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Credential | PHD
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Telephone | 240-463-3445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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