Organization
GENESIS SPORTS MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERICHARD REDELL MCCOY SR. (OWNER)
(980) 253-1393
Entity
Organization
Contact information
Practice address
2861 OASIS LN, CHARLOTTE, NC 28214-8866
(704) 587-2679
Mailing address
2861 OASIS LN, CHARLOTTE, NC 28214-8866
(704) 587-2679
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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