Provider Demographics
NPI:1144604273
Name:JUSTIS GROUP OF EDENTON
Entity Type:Organization
Organization Name:JUSTIS GROUP OF EDENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-990-0595
Mailing Address - Street 1:117 DENBURY DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-9670
Mailing Address - Country:US
Mailing Address - Phone:336-990-0595
Mailing Address - Fax:
Practice Address - Street 1:905 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4251
Practice Address - Country:US
Practice Address - Phone:336-990-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty