Organization
ERNEST JETER, MSED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST JETER MSED (OWNER)
(347) 596-7357
Entity
Organization
Contact information
Practice address
115 S SYCAMORE ST STE B, PETERSBURG, VA 23803-4279
(347) 596-7357
(804) 479-3373
Mailing address
1640 JOHNSON RD APT 114B, PETERSBURG, VA 23805-1258
(347) 596-7357
(804) 479-3373
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
12/27/2017
Last updated
12/27/2017
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