Individual
JEREMY SCOTT SUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
701 BENONI AVE, FAIRMONT, WV 26554-0045
(681) 404-6135
Mailing address
701 BENONI AVE, FAIRMONT, WV 26554-0045
(681) 404-6135
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/01/2021
Last updated
07/01/2021
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