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601 Morris St Ste 203 Charleston WV 25301-1416 | |
| (304) 720-0221 | |
| (678) 903-0962 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 601 Morris St Ste 203, Charleston, West Virginia |
| Authorized Official Name and Position | Jonathan B Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | 601 Morris St Ste 203 Charleston WV 25301-1416 Ph: (304) 720-0221 |
| NPI Number | 1124792296 |
|---|---|
| Provider Enumeration Date | 08/03/2021 |
| Last Update Date | 08/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124792296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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