Healthcare Provider Details

I. General information

NPI: 1114015716
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15068 LEE HWY SUITE 900
BRISTOL VA
24202-4263
US

IV. Provider business mailing address

15068 LEE HWY SUITE 900
BRISTOL VA
24202-4263
US

V. Phone/Fax

Practice location:
  • Phone: 276-645-4900
  • Fax: 276-645-4913
Mailing address:
  • Phone: 276-645-4900
  • Fax: 276-645-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: VANESSA WALKER-HARRIS
Title or Position: DIRECTOR OF OFFICE OF FAMILY HEALTH
Credential: M.D.
Phone: 804-864-7170