Provider Demographics
NPI:1528847761
Name:DYNAMIC GROUP SERVICES
Entity type:Organization
Organization Name:DYNAMIC GROUP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-258-5176
Mailing Address - Street 1:8911 ELIZABETH BENNET PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-9050
Mailing Address - Country:US
Mailing Address - Phone:252-258-5176
Mailing Address - Fax:
Practice Address - Street 1:505 SUNSET AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5616
Practice Address - Country:US
Practice Address - Phone:919-673-8240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty