| NPI | 1992134423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE HAGAN JACKSON Owner/Provider 804-588-6993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101238219) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |