Provider Demographics
NPI:1134395130
Name:JBG MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:JBG MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-265-6656
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1283
Mailing Address - Country:US
Mailing Address - Phone:972-265-6634
Mailing Address - Fax:972-265-6631
Practice Address - Street 1:5700 GRANITE PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6622
Practice Address - Country:US
Practice Address - Phone:972-265-6634
Practice Address - Fax:972-265-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies