Healthcare Provider Details

I. General information

NPI: 1922510361
Provider Name (Legal Business Name): WZD MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GREENBRIER PKWY STE B
CHESAPEAKE VA
23320-3822
US

IV. Provider business mailing address

801 GREENBRIER PKWY STE B
CHESAPEAKE VA
23320-3822
US

V. Phone/Fax

Practice location:
  • Phone: 757-819-7547
  • Fax: 757-842-6570
Mailing address:
  • Phone: 757-819-7547
  • Fax: 757-842-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RUTH ANN WATSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 757-819-7547