Healthcare Provider Details

I. General information

NPI: 1053418384
Provider Name (Legal Business Name): ALLISON S MCINNIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON SMITH PA

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 POCAHONTAS TRAIL
QUINTON VA
23141-0007
US

IV. Provider business mailing address

4630 S LABURNUM AVE SUITE B
RICHMOND VA
23231-2424
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-4388
  • Fax: 804-932-9860
Mailing address:
  • Phone: 804-222-5511
  • Fax: 804-222-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002145
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: