Healthcare Provider Details

I. General information

NPI: 1336388479
Provider Name (Legal Business Name): THE FAMILY MATERNITY CENTER OF THE NORTHERN NECK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 FLEETS LN
WHITE STONE VA
22578-2019
US

IV. Provider business mailing address

PO BOX 1866
KILMARNOCK VA
22482-1866
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-3504
  • Fax: 804-435-0517
Mailing address:
  • Phone: 804-435-3504
  • Fax: 804-435-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY C. DODSON-MCADOO
Title or Position: PRESIDENT
Credential: RN, ANP-C
Phone: 804-435-3504