Genesis Sports Management

NPI 1063726388 - Community/Behavioral Health - 251S00000X

NPI Details
NPI 1063726388
Enumeration Date 07/28/2010
Last Updated 07/28/2010
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name DERICHARD REDELL DERICHARD
Position OWNER
Phone (704) 587-2679
Fax
Practice Location
2861 OASIS LN
CHARLOTTE NC, 28214-8866, US
Phone (704) 587-2679
Fax
Business Location
2861 OASIS LN
CHARLOTTE NC, 28214-8866, US
Phone (704) 587-2679
Fax
Toxanomy
Taxonomy Code 251S00000X
License State
License Number
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According to our database, Genesis Sports Management NPI is 1063726388, taxonomy code is 251S00000X Genesis Sports Management physically located at 2861 Oasis Ln, Charlotte NC, 28214-8866. NPI Number 1033115704 has the healthcare provider type.

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1063726388 NPI number is provided on an as is basis without warranty of any kind. 1063726388 is maintained by the National Plan & Provider Enumeration System. The contents of Genesis Sports Management are for informational purposes only.