Healthcare Provider Details

I. General information

NPI: 1508817735
Provider Name (Legal Business Name): ADOLESCENT HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13821 VILLAGE MILL DR
MIDLOTHIAN VA
23114-4365
US

IV. Provider business mailing address

13821 VILLAGE MILL DR
MIDLOTHIAN VA
23114-4365
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-8900
  • Fax: 804-378-2012
Mailing address:
  • Phone: 804-794-8900
  • Fax: 804-378-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number19411
License Number StateVA

VIII. Authorized Official

Name: DR. GEORGE M BRIGHT
Title or Position: OWNER
Credential: MD
Phone: 804-794-8900