Healthcare Provider Details

I. General information

NPI: 1366323941
Provider Name (Legal Business Name): DOC BOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 OLD BRICK RD STE 60
GLEN ALLEN VA
23060-5841
US

IV. Provider business mailing address

2400 OLD BRICK RD STE 60
GLEN ALLEN VA
23060-5841
US

V. Phone/Fax

Practice location:
  • Phone: 804-286-6224
  • Fax:
Mailing address:
  • Phone: 804-286-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JACKSON GREEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-286-6224