Organization
GROUP SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO FOZARD (CEO)
(919) 697-6957
Entity
Organization
Contact information
Practice address
1503 DENIM DR, SUITE 101, ERWIN, NC 28339-3017
(919) 822-2172
Mailing address
PO BOX 12821, RTP, NC 27709-2821
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5918588
—
NC
Enumeration date
10/18/2011
Last updated
08/28/2012
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