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General NPI Number Information
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NPI Number | 1245959287
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PRIMARY CARE
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 7605 FOREST AVE STE 412
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City | RICHMOND
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State | VA
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Zip | 23229-4941
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Country | US
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Telephone | 804-381-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 7605 FOREST AVE STE 412
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City | RICHMOND
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State | VA
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Zip | 23229-4941
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Country | US
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Telephone | 804-381-6252
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES DETRICK
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Credential |
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Telephone | 804-381-6252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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