Healthcare Provider Details

I. General information

NPI: 1447305057
Provider Name (Legal Business Name): CHILDRENS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BULIFANTS BLVD
WILLIAMSBURG VA
23188-5709
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-7337
  • Fax: 757-564-3205
Mailing address:
  • Phone: 757-668-7017
  • Fax: 757-668-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN J ABSHIRE
Title or Position: SENIOR VP/CFO
Credential:
Phone: 757-668-8565