Healthcare Provider Details

I. General information

NPI: 1396156410
Provider Name (Legal Business Name): NORTON COMMUNITY PHYSICIANS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 15TH ST NW SUITE 111
NORTON VA
24273-1620
US

IV. Provider business mailing address

509 MEDTECH PKWY
JOHNSON CITY TN
37604
US

V. Phone/Fax

Practice location:
  • Phone: 276-439-1463
  • Fax: 276-439-1464
Mailing address:
  • Phone: 423-952-2122
  • Fax: 423-952-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE D MULLINS
Title or Position: AUTHORIZED SIGNATOR
Credential:
Phone: 276-365-3060