Healthcare Provider Details

I. General information

NPI: 1215601562
Provider Name (Legal Business Name): ROBERT LEE TALBOTT III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 LEESVILLE RD
LYNCHBURG VA
24502-2828
US

IV. Provider business mailing address

693 LEESVILLE RD
LYNCHBURG VA
24502-2828
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5220
  • Fax: 434-237-1737
Mailing address:
  • Phone: 434-200-5220
  • Fax: 434-237-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: