Organization
AMETHYST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMMY SHERRELL COLEMAN (OWNER)
(252) 230-0631
Entity
Organization
Contact information
Practice address
806 NE ROUNDTREE STREET, WILSON, NC 27893-0806
(252) 230-0631
Mailing address
806 NE ROUNDTREE STREET, WILSON, NC 27893-0806
(252) 230-0631
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
1207282
NC
Other
Enumeration date
07/25/2013
Last updated
07/25/2013
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