Individual
MR. DARNELL ANTONIO PEGRAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2211 LAKE CLUB DR, COLUMBUS, OH 43232-3204
(614) 318-9788
Mailing address
1114 GOLDENEYE DR, BLACKLICK, OH 43004-7001
(614) 318-9788
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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