Healthcare Provider Details

I. General information

NPI: 1437144789
Provider Name (Legal Business Name): DR. JAMES H PRIEST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 HAMILTON BLVD
SOUTH BOSTON VA
24592-5200
US

IV. Provider business mailing address

420 HAMILTON BLVD
SOUTH BOSTON VA
24592-5200
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8975
  • Fax: 434-575-0086
Mailing address:
  • Phone: 434-572-8975
  • Fax: 434-575-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number04920
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: