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Organization
JOHNSON C. SMITH UNIVERSITY
Active
Organization
JOHNSON C. SMITH UNIVERSITY
Active
Other names
JCS University Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
100 BEATTIES FORD RD, CHARLOTTE, NC 28216-5302
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
NC200001254
NC
Other
Enumeration date
03/10/2017
Last updated
03/10/2017
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