Healthcare Provider Details

I. General information

NPI: 1841566734
Provider Name (Legal Business Name): DLP TWIN COUNTY PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL DR
GALAX VA
24333-2227
US

IV. Provider business mailing address

200 HOSPITAL DR
GALAX VA
24333-2227
US

V. Phone/Fax

Practice location:
  • Phone: 276-238-2535
  • Fax: 276-238-2536
Mailing address:
  • Phone: 276-238-2535
  • Fax: 276-238-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

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