Healthcare Provider Details

I. General information

NPI: 1245313857
Provider Name (Legal Business Name): NANSEMOND FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 GUMWOOD DR SUITE A
SMITHFIELD VA
23430-6087
US

IV. Provider business mailing address

206 GUMWOOD DR SUITE A
SMITHFIELD VA
23430-6087
US

V. Phone/Fax

Practice location:
  • Phone: 757-365-9090
  • Fax: 757-365-9095
Mailing address:
  • Phone: 757-365-9090
  • Fax: 757-365-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101045475
License Number StateVA

VIII. Authorized Official

Name: DR. DONALD ELWOOD SOLES JR.
Title or Position: MEMBER
Credential: M.D.
Phone: 757-365-9090