Healthcare Provider Details

I. General information

NPI: 1235742529
Provider Name (Legal Business Name): DOGWOOD MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CEDAR GROVE RD
FARNHAM VA
22460
US

IV. Provider business mailing address

PO BOX 11768
RICHMOND VA
23230-0168
US

V. Phone/Fax

Practice location:
  • Phone: 804-971-8314
  • Fax: 804-213-9783
Mailing address:
  • Phone: 804-281-3319
  • Fax: 804-213-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIN FRYE
Title or Position: PRESIDENT
Credential: NP
Phone: 804-971-8314