Healthcare Provider Details

I. General information

NPI: 1255607941
Provider Name (Legal Business Name): DLP TWIN COUNTY PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GLENDALE RD
GALAX VA
24333-2208
US

IV. Provider business mailing address

500 GLENDALE RD
GALAX VA
24333-2208
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-0179
  • Fax: 276-238-3561
Mailing address:
  • Phone: 276-236-0179
  • Fax: 276-238-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000