Healthcare Provider Details

I. General information

NPI: 1609472216
Provider Name (Legal Business Name): WYTHE WOMEN'S HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 W LEE HWY
WYTHEVILLE VA
24382-1437
US

IV. Provider business mailing address

1787 W LEE HWY
WYTHEVILLE VA
24382-1437
US

V. Phone/Fax

Practice location:
  • Phone: 276-228-3355
  • Fax: 276-228-6665
Mailing address:
  • Phone: 276-228-3355
  • Fax: 276-228-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BRADLEY TERRY
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 276-228-3355