Healthcare Provider Details

I. General information

NPI: 1629042817
Provider Name (Legal Business Name): JONATHAN CHRISTIAN ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 RICHMOND AVE.
STAUNTON VA
24401-9146
US

IV. Provider business mailing address

1355 RICHMOND AVE.
STAUNTON VA
24401-9146
US

V. Phone/Fax

Practice location:
  • Phone: 540-332-2100
  • Fax: 540-332-2201
Mailing address:
  • Phone: 540-332-2100
  • Fax: 540-332-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number010104862
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: