Healthcare Provider Details

I. General information

NPI: 1770867079
Provider Name (Legal Business Name): AMANDA DOOLEY GRIFFIN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 STONY POINT DR
RICHMOND VA
23235-1979
US

IV. Provider business mailing address

9105 STONY POINT DRIVE
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-9105
  • Fax: 804-287-6119
Mailing address:
  • Phone: 804-330-9105
  • Fax: 804-521-1061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024169657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: