Healthcare Provider Details

I. General information

NPI: 1770597213
Provider Name (Legal Business Name): OB-GYN CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR SUITE 201
MARTINSVILLE VA
24112-1927
US

IV. Provider business mailing address

315 HOSPITAL DR SUITE 201
MARTINSVILLE VA
24112-1927
US

V. Phone/Fax

Practice location:
  • Phone: 276-638-8881
  • Fax: 276-638-3268
Mailing address:
  • Phone: 276-638-8881
  • Fax: 276-638-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101028353
License Number StateVA

VIII. Authorized Official

Name: DR. PAUL ALFRED HOLYFIELD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 276-638-8881