Healthcare Provider Details

I. General information

NPI: 1619243300
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: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DOCTORS PARK
GALAX VA
24333-2276
US

IV. Provider business mailing address

106 DOCTORS PARK
GALAX VA
24333-2276
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-8166
  • Fax: 276-236-5247
Mailing address:
  • Phone: 276-236-8166
  • Fax: 276-236-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JESS N JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-372-8500