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General NPI Number Information
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NPI Number | 1740868744
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Entity Type | Organization
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Legal Business Name | WHITEVILLE MAT SERVICES, INC.
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 109 LESLIE NEWSOME AVE
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City | WHITEVILLE
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State | NC
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Zip | 28472-4937
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Country | US
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Telephone | 919-889-5118
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Fax |
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Provider Business Mailing Address
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Address Line | 109 LESLIE NEWSOME AVE
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City | WHITEVILLE
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State | NC
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Zip | 28472-4937
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Country | US
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Telephone | 919-889-5118
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GRADY B. JEFFERYS JR.
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Credential | PH.D.
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Telephone | 828-173-1643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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