Healthcare Provider Details

I. General information

NPI: 1912006040
Provider Name (Legal Business Name): SPARKS & MACCARTY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 HAMILTON BLVD
SOUTH BOSTON VA
24592-5200
US

IV. Provider business mailing address

422 HAMILTON BLVD
SOUTH BOSTON VA
24592-5200
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-4074
  • Fax: 434-572-4712
Mailing address:
  • Phone: 434-572-4074
  • Fax: 434-572-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL C SPARKS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 434-572-4074