Provider Demographics
NPI:1528684404
Name:YOUR FIRST CHOICE DOC LLC
Entity type:Organization
Organization Name:YOUR FIRST CHOICE DOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/HCP
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-FNP
Authorized Official - Phone:731-618-6177
Mailing Address - Street 1:8869 CAMPALDINO AVE
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3631
Mailing Address - Country:US
Mailing Address - Phone:731-618-6177
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4439
Practice Address - Country:US
Practice Address - Phone:800-409-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care