Fredericks, Corey Jordan
Fredericks, Corey Jordan is an sole proprietor health care provider with primary practice located at 1601 E Market St , Greensboro NC 27411-0002. He recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as his primary health care specialty. Fredericks, Corey Jordan can be contacted via phone (718) 798-1418.Contact Information
Primary practice address
1601 E Market St
Greensboro NC 27411-0002
Phone: (718) 798-1418
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / School | 101YS0200X | 3344567 | North Carolina |
Profile Details
| NPI number | 1205509395 |
|---|---|
| LBN Legal business name | Fredericks, Corey Jordan |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 26th, 2021 |
| Last updated | Jul 26th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205509395 | NPPES |
| North Carolina | MEDICAID | 567DP244 |
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