Healthcare Provider Details

I. General information

NPI: 1881577336
Provider Name (Legal Business Name): GEORGIA RUBIANE MEIRA DO ROSARIO DE SOUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S MAIN ST
BLACKSBURG VA
24060-7017
US

IV. Provider business mailing address

3700 S MAIN ST
BLACKSBURG VA
24060-7017
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-1111
  • Fax:
Mailing address:
  • Phone: 540-951-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116042710
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: