Healthcare Provider Details

I. General information

NPI: 1407064413
Provider Name (Legal Business Name): CHRISTI LEA HUGHART D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 WILBORN AVE STE C
SOUTH BOSTON VA
24592-1662
US

IV. Provider business mailing address

2202 BEECHMONT RD STE A
SOUTH BOSTON VA
24592-1614
US

V. Phone/Fax

Practice location:
  • Phone: 434-517-8893
  • Fax:
Mailing address:
  • Phone: 434-333-7760
  • Fax: 434-333-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0102202810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: