Healthcare Provider Details

I. General information

NPI: 1104465103
Provider Name (Legal Business Name): SPERO HEALTH OF VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 FAIRY STREET EXT
MARTINSVILLE VA
24112-1913
US

IV. Provider business mailing address

155 FRANKLIN RD STE 430
BRENTWOOD TN
37027-4646
US

V. Phone/Fax

Practice location:
  • Phone: 276-201-1647
  • Fax: 276-226-2643
Mailing address:
  • Phone: 615-265-0371
  • Fax: 615-844-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD DULANY ADAMS
Title or Position: CFO
Credential:
Phone: 615-265-0371