Organization
JOHNSON C. SMITH UNIVERSITY
Active
Other names
JCS University Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS III (AGENT)
(972) 367-4845
Entity
Organization
Contact information
Practice address
100 BEATTIES FORD RD, CHARLOTTE, NC 28216-5302
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD., DALLAS, TX 75244-3909
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
NC200001254
NC
Other
Enumeration date
03/10/2017
Last updated
03/10/2017
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