Healthcare Provider Details

I. General information

NPI: 1841037843
Provider Name (Legal Business Name): CENTRA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK ST
FARMVILLE VA
23901-1199
US

IV. Provider business mailing address

PO BOX 829829
PHILADELPHIA PA
19182-9829
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-2072
  • Fax: 434-200-4252
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SONYA R TURNER
Title or Position: SR. DIRECTOR PFS
Credential:
Phone: 434-200-6942