Healthcare Provider Details

I. General information

NPI: 1912712340
Provider Name (Legal Business Name): RHONDA MCCLINTON GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 MEDICAL GROUP SGHM 77 NEALY AVENUE
LANGLEY AFB VA
23665
US

IV. Provider business mailing address

633 MEDICAL GROUP SGHM 77 NEALY AVENUE
LANGLEY AFB VA
23665
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-2190
  • Fax:
Mailing address:
  • Phone: 757-225-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001068594
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: