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General NPI Number Information
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NPI Number | 1114943875
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Entity Type | Organization
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Legal Business Name | PRESTON SQUARE FAMILY PRACTICE
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 24294 TEAL DRIVE
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City | ABINGDON
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State | VA
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Zip | 24211-6160
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Country | US
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Telephone | 276-628-8303
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Fax | 276-466-4815
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Provider Business Mailing Address
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Address Line | 24294 TEAL DRIVE
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City | ABINGDON
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State | VA
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Zip | 24211-6160
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Country | US
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Telephone | 276-628-8303
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Fax | 276-466-4815
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Authorized Official
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Title or Position | PARTNER
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Name | CLARA JANE TOOTHMAN
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Credential | MD
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Telephone | 276-628-8303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | VA
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