| NPI | 1982894911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER GAINES Credentialing Specialist 757-256-4289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 225100000X Physical Therapist |
| 170100000X Medical Genetics, Ph.D. Medical Genetics | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 103TC1900X Psychologist, Counseling | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2025-09-18 |