Organization
STATE OF THE BODY LLC
Active
Other names
State of the Body LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EBONI MCCOY NURSE PRACTITIONER (PRESIDENT)
(919) 880-8115
Entity
Organization
Contact information
Practice address
1133 WEDGEWOOD RD, BALTIMORE, MD 21229-1247
(919) 880-8115
Mailing address
1133 WEDGEWOOD RD, BALTIMORE, MD 21229-1247
(919) 880-8115
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/23/2024
Last updated
11/23/2024
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