Healthcare Provider Details

I. General information

NPI: 1992235501
Provider Name (Legal Business Name): ANTUANE DEWAYNE LOMAX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 39TH STREET
NEWPORT NEWS VA
23607
US

IV. Provider business mailing address

1310 39TH ST
NEWPORT NEWS VA
23607-2400
US

V. Phone/Fax

Practice location:
  • Phone: 757-245-3005
  • Fax: 757-245-3006
Mailing address:
  • Phone: 757-245-3005
  • Fax: 757-245-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: