Healthcare Provider Details

I. General information

NPI: 1649537440
Provider Name (Legal Business Name): GREGORY C MAYS M.D., P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INTERSTATE DR
COVINGTON VA
24426-6441
US

IV. Provider business mailing address

201 INTERSTATE DR
COVINGTON VA
24426-6441
US

V. Phone/Fax

Practice location:
  • Phone: 540-962-4621
  • Fax: 540-962-7573
Mailing address:
  • Phone: 540-962-4621
  • Fax: 540-962-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101056393
License Number StateVA

VIII. Authorized Official

Name: DR. GREGORY MAYS
Title or Position: MEMBER
Credential: M.D.
Phone: 540-962-4621