Healthcare Provider Details

I. General information

NPI: 1558829846
Provider Name (Legal Business Name): JONATHAN BRICE ARRINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MACCORKLE AVE SE RM 409
CHARLESTON WV
25304-1045
US

IV. Provider business mailing address

1469 BRICK CHURCH RD
ROCKY MOUNT VA
24151-4054
US

V. Phone/Fax

Practice location:
  • Phone: 860-221-4887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberT66847070
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: