Healthcare Provider Details

I. General information

NPI: 1184632119
Provider Name (Legal Business Name): PBJG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 RIVERSIDE DR. SUITE D
DANVILLE VA
24541
US

IV. Provider business mailing address

159 EXECUTIVE DR SUITE H
DANVILLE VA
24541-4160
US

V. Phone/Fax

Practice location:
  • Phone: 434-797-4357
  • Fax: 434-797-4505
Mailing address:
  • Phone: 434-792-4663
  • Fax: 434-793-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANET R HAMILTON
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N.
Phone: 434-792-4663