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General NPI Number Information
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NPI Number | 1245477223
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Entity Type | Organization
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Legal Business Name | COMPLEXIONS OF CENTRAL VIRGINIA, INC.
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 1922 THOMSON DR STE B
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City | LYNCHBURG
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State | VA
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Zip | 24501-1020
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Country | US
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Telephone | 434-846-4444
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Fax | 434-846-4445
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Provider Business Mailing Address
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Address Line | 1922 THOMSON DR STE B
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City | LYNCHBURG
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State | VA
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Zip | 24501-1020
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Country | US
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Telephone | 434-846-4444
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Fax | 434-846-4445
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD A MILLER
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Credential | M.D.
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Telephone | 434-846-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101059327
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License Number State | VA
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