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Organization
J & G FAMILY PRACTICE LLC
Active
Organization
J & G FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NGUM AVWONTOM FNP-BC (PRESIDENT)
(301) 404-1989
Entity
Organization
Contact information
Practice address
9331 LIBERTY RD # 2C, RANDALLSTOWN, MD 21133-3525
(410) 701-8485
(410) 701-8524
Mailing address
9331 LIBERTY RD # 2C, RANDALLSTOWN, MD 21133-3525
(410) 701-8485
(410) 701-8524
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/01/2022
Last updated
09/08/2026
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