Healthcare Provider Details

I. General information

NPI: 1801386701
Provider Name (Legal Business Name): JACOB ALLEN SCRIBNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 225
SUFFOLK VA
23434-8155
US

IV. Provider business mailing address

2790 GODWIN BLVD STE 225
SUFFOLK VA
23434-8155
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4550
  • Fax: 757-514-2250
Mailing address:
  • Phone: 757-934-4550
  • Fax: 757-514-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0102210109
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2023-01816
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: