Healthcare Provider Details

I. General information

NPI: 1689586984
Provider Name (Legal Business Name): CARL GERMAIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8124 GALATEA PL
CHESTERFIELD VA
23838-6287
US

IV. Provider business mailing address

8124 GALATEA PL
CHESTERFIELD VA
23838-6287
US

V. Phone/Fax

Practice location:
  • Phone: 804-503-1587
  • Fax:
Mailing address:
  • Phone: 804-503-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000359
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: