Provider Demographics
NPI:1154624146
Name:ABG PROVIDER SERVICES
Entity type:Organization
Organization Name:ABG PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOSHIKA
Authorized Official - Middle Name:LAVOCIETTE
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-318-8224
Mailing Address - Street 1:434 OFERRELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7628
Mailing Address - Country:US
Mailing Address - Phone:910-318-8224
Mailing Address - Fax:
Practice Address - Street 1:434 OFERRELL ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7628
Practice Address - Country:US
Practice Address - Phone:910-318-8224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health