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1619540705
CHARLES WAYNE MCDONOUGH
RICHMOND, VA
NPI
1619540705
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: VA 0024182163)
Enumeration Date
2021-07-19
Last Update Date
2021-07-19
Business Address
CHARLES WAYNE MCDONOUGH
6714 PATTERSON AVE STE 204
RICHMOND, VA 23226-3432
Phone number: 804-282-3387
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Mailing Address
CHARLES WAYNE MCDONOUGH
9212 SHADY GROVE RD
MECHANICSVILLE, VA 23116-2845
Phone number: 804-873-9379
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