| NPI | 1518430925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK AINSLEY INNIS Md 434-421-6180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2024-04-05 |