Healthcare Provider Details

I. General information

NPI: 1427359090
Provider Name (Legal Business Name): HIGHLANDS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 JOHNSON ST
ABINGDON VA
24210-2934
US

IV. Provider business mailing address

PO BOX 570
ABINGDON VA
24212-0570
US

V. Phone/Fax

Practice location:
  • Phone: 276-623-8100
  • Fax: 276-623-8126
Mailing address:
  • Phone: 276-623-8100
  • Fax: 276-623-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101059370
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101051074
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101243877
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101050628
License Number StateVA

VIII. Authorized Official

Name: MRS. SONYA DUNCAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 276-623-8100