Healthcare Provider Details

I. General information

NPI: 1598777997
Provider Name (Legal Business Name): MALINDA A BROOKS-WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 N SOUTHSIDE PLAZA ST FAMILY MEDICINE
RICHMOND VA
23224-1742
US

IV. Provider business mailing address

PO BOX 758997
BALTIMORE MD
21275-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-230-7777
  • Fax: 804-230-7798
Mailing address:
  • Phone: 804-828-4842
  • Fax: 804-828-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01010137725
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: