Healthcare Provider Details

I. General information

NPI: 1134152077
Provider Name (Legal Business Name): MARION PEDIATRIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 RADIO HILL RD SUITE ONE
MARION VA
24354-4224
US

IV. Provider business mailing address

590 RADIO HILL RD SUITE ONE
MARION VA
24354-4224
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-8183
  • Fax: 276-782-9267
Mailing address:
  • Phone: 276-783-8183
  • Fax: 276-782-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101028363
License Number StateVA

VIII. Authorized Official

Name: GEORGE F JONES
Title or Position: PHYSICIAN
Credential: MD
Phone: 276-783-8183