Healthcare Provider Details

I. General information

NPI: 1225822174
Provider Name (Legal Business Name): CENTRA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 LANGHORNE RD STE 301
LYNCHBURG VA
24501-1423
US

IV. Provider business mailing address

PO BOX 749379
ATLANTA GA
30374-9379
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-4175
  • Fax: 434-200-1679
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: SONYA R TURNER
Title or Position: SR. DIRECTOR REVENUE CYCLE
Credential:
Phone: 434-200-6942