Healthcare Provider Details

I. General information

NPI: 1720445299
Provider Name (Legal Business Name): DLP TWIN COUNTY PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 E STUART DR
GALAX VA
24333-2407
US

IV. Provider business mailing address

961 E STUART DR
GALAX VA
24333-2407
US

V. Phone/Fax

Practice location:
  • Phone: 276-238-0439
  • Fax: 276-238-0404
Mailing address:
  • Phone: 276-238-0439
  • Fax: 276-238-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-513-2763