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General NPI Number Information
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NPI Number | 1174324610
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Entity Type | Organization
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Legal Business Name | ADVANCED MOBILE WOUND CARE OF VIRGINIA LLC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 2109 INDIA RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-2886
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Country | US
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Telephone | 276-685-1185
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 INDIA RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-2886
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Country | US
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Telephone | 276-685-1185
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KRISTIN NORMAN
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Credential |
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Telephone | 276-685-1185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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