Healthcare Provider Details

I. General information

NPI: 1124243050
Provider Name (Legal Business Name): CAROL B USSERY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 KIMBERSHELL PL
RICHMOND VA
23229-8436
US

IV. Provider business mailing address

8205 KIMBERSHELL PL
RICHMOND VA
23229-8436
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-1192
  • Fax:
Mailing address:
  • Phone: 804-285-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101042666
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: