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General NPI Number Information
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NPI Number | 1215093703
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPECIALISTS FOR CJW LLC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7157 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4017
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Country | US
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Telephone | 804-523-8061
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Fax | 804-523-8066
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Provider Business Mailing Address
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Address Line | 7157 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4017
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Country | US
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Telephone | 804-523-8061
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Fax | 804-523-8066
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CAROL SMITH
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Credential |
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Telephone | 800-661-3365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | VA
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