Healthcare Provider Details

I. General information

NPI: 1053380352
Provider Name (Legal Business Name): RALPH D HELLAMS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 RIVER RD W
MANAKIN SABOT VA
23103-3200
US

IV. Provider business mailing address

294 RIVER RD W
MANAKIN SABOT VA
23103-3200
US

V. Phone/Fax

Practice location:
  • Phone: 804-784-8800
  • Fax: 804-784-7203
Mailing address:
  • Phone: 804-784-8800
  • Fax: 804-784-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101056184
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: