Healthcare Provider Details

I. General information

NPI: 1417588666
Provider Name (Legal Business Name): MRS. DONNA AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 ELK GARDEN RD
LEBANON VA
24266-6604
US

IV. Provider business mailing address

1314 ELK GARDEN RD
LEBANON VA
24266-6604
US

V. Phone/Fax

Practice location:
  • Phone: 276-701-4466
  • Fax:
Mailing address:
  • Phone: 276-701-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License NumberT66501724
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: