| NPI | 1871131664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing & Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2022-06-02 |