Healthcare Provider Details

I. General information

NPI: 1275006843
Provider Name (Legal Business Name): COMER GAITHER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SCHOOL BOARD CT
MADISON VA
22727-3096
US

IV. Provider business mailing address

60 SCHOOL BOARD CT
MADISON VA
22727-3096
US

V. Phone/Fax

Practice location:
  • Phone: 540-948-5143
  • Fax:
Mailing address:
  • Phone: 540-948-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number328941655
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000801
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: