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General NPI Number Information
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NPI Number | 1144838608
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Entity Type | Organization
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Legal Business Name | GMGP HEALTH GROUP LLC
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 1401 JOHNSTON WILLIS DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4730
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Country | US
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Telephone | 336-816-2589
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 MAPLEWOOD AVE STE G
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City | RICHMOND
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State | VA
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Zip | 23220-5700
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Country | US
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Telephone | 336-816-2589
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDOLPH JENKINS
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Credential | MD
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Telephone | 336-816-2589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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