Healthcare Provider Details

I. General information

NPI: 1710936729
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 COURT STREET
APPOMATTOX VA
24522
US

IV. Provider business mailing address

PO BOX 355 475 COURT STREET
APPOMATTOX VA
24522-0355
US

V. Phone/Fax

Practice location:
  • Phone: 434-352-2313
  • Fax:
Mailing address:
  • Phone: 434-352-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: KERRY GATELEY
Title or Position: DIRECTOR CENTRAL VA. HEALTH DISTRIC
Credential: MD
Phone: 434-947-6777