Provider Demographics
NPI:1922647874
Name:BJUTIFUL SOUL
Entity Type:Organization
Organization Name:BJUTIFUL SOUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KJUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-961-8218
Mailing Address - Street 1:12830 ENGLISH WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5027
Mailing Address - Country:US
Mailing Address - Phone:704-961-8218
Mailing Address - Fax:
Practice Address - Street 1:8510 MCALPINE PARK DR STE 209
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-6250
Practice Address - Country:US
Practice Address - Phone:980-494-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty