Healthcare Provider Details

I. General information

NPI: 1366495491
Provider Name (Legal Business Name): AMELIA HOLDER COLLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9606 PATTERSON AVE
RICHMOND VA
23229-6027
US

IV. Provider business mailing address

9606 PATTERSON AVE
RICHMOND VA
23229-6027
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-6171
  • Fax: 804-741-3105
Mailing address:
  • Phone: 804-740-6171
  • Fax: 804-741-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101043322
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: