Healthcare Provider Details

I. General information

NPI: 1578501060
Provider Name (Legal Business Name): CJW INFECTIOUS DISEASE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

7117 JAHNKE RD
RICHMOND VA
23225-4017
US

V. Phone/Fax

Practice location:
  • Phone: 804-228-6880
  • Fax: 804-228-6883
Mailing address:
  • Phone: 804-228-6880
  • Fax: 804-228-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL SMITH
Title or Position: VP
Credential:
Phone: 804-237-7760