Healthcare Provider Details

I. General information

NPI: 1922182112
Provider Name (Legal Business Name): GRAYSON HIGHLANDS FAMILY MEDICINE & OBSTETRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 EAST MAIN STREET
INDEPENDENCE VA
24348
US

IV. Provider business mailing address

PO BOX 947
INDEPENDENCE VA
24348-0947
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-2865
  • Fax: 276-773-0843
Mailing address:
  • Phone: 276-773-2865
  • Fax: 276-773-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101057835
License Number StateVA

VIII. Authorized Official

Name: ANGELA R LINEBERRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 276-773-2865