Healthcare Provider Details

I. General information

NPI: 1982209284
Provider Name (Legal Business Name): RECORIAN WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8324 BELL CREEK RD STE 100
MECHANICSVILLE VA
23116-3848
US

IV. Provider business mailing address

1721 STEVENS STREET
HENRICO VA
23231
US

V. Phone/Fax

Practice location:
  • Phone: 804-522-5500
  • Fax: 804-522-5501
Mailing address:
  • Phone: 804-690-3836
  • Fax: 804-522-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HERBERT JEROME CUMMINGS
Title or Position: CEO
Credential:
Phone: 804-690-3836