Individual
MR. MOORE BYNUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
518 ARLINGTON ST, ROCKY MOUNT, NC 27801-5657
(252) 446-2082
Mailing address
131 BYNUM PL, NORLINA, NC 27563-9139
(252) 257-2307
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-033-054
NC
Other
Enumeration date
01/22/2008
Last updated
01/22/2008
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