Healthcare Provider Details

I. General information

NPI: 1336676162
Provider Name (Legal Business Name): GRANT WOODFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 FOREST AVE STE 300
RICHMOND VA
23230-1730
US

IV. Provider business mailing address

6900 FOREST AVE STE 300
RICHMOND VA
23230-1730
US

V. Phone/Fax

Practice location:
  • Phone: 804-346-1515
  • Fax: 804-270-2888
Mailing address:
  • Phone: 804-346-1515
  • Fax: 804-270-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101269053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: