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General NPI Number Information
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NPI Number | 1619505138
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Entity Type | Organization
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Legal Business Name | BJUTIFUL SOUL HEALTH
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 144 BATTLEY DAIRY RD
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City | HAMLET
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State | NC
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Zip | 28345-7253
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Country | US
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Telephone | 980-494-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 12830 ENGLISH WALNUT LN
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City | CHARLOTTE
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State | NC
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Zip | 28215-5027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | MS. KJUANA DIGGS
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Credential |
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Telephone | 170-496-1821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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