Healthcare Provider Details

I. General information

NPI: 1134320526
Provider Name (Legal Business Name): JUSTIN GUY MYERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 ATLEE ROAD EMERGENCY DEPARTMENT
MECHANICSVILLE VA
23116
US

IV. Provider business mailing address

709 N 24TH ST
RICHMOND VA
23223-6407
US

V. Phone/Fax

Practice location:
  • Phone: 804-569-7007
  • Fax:
Mailing address:
  • Phone: 804-564-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116017420
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102202183
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number188876
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: