Individual
JUSTICE SAMUELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 BRADDOCK ST, FAIRMONT, WV 26554-2208
(304) 502-2550
Mailing address
200 BRADDOCK ST, FAIRMONT, WV 26554-2208
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/10/2021
Last updated
02/10/2021
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