Healthcare Provider Details

I. General information

NPI: 1598737181
Provider Name (Legal Business Name): JAMES MICHAEL PONDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 FAIRVIEW DR SUITE B
FRANKLIN VA
23851
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 757-562-2158
  • Fax: 757-562-2134
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101031113
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: