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General NPI Number Information
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NPI Number | 1528847761
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Entity Type | Organization
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Legal Business Name | DYNAMIC GROUP SERVICES
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 505 SUNSET AVE STE B
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-5616
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Country | US
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Telephone | 919-673-8240
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Fax |
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Provider Business Mailing Address
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Address Line | 8911 ELIZABETH BENNET PL
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City | RALEIGH
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State | NC
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Zip | 27616-9050
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Country | US
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Telephone | 252-258-5176
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTINA BAZEMORE
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Credential |
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Telephone | 252-258-5176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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