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General NPI Number Information
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NPI Number | 1427232735
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Entity Type | Organization
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Legal Business Name | MECKLENBURG FAMILY PRACTICE
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 969 MADISON ST
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City | BOYDTON
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State | VA
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Zip | 23917-0297
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Country | US
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Telephone | 434-738-6911
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Fax | 434-738-0431
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Provider Business Mailing Address
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Address Line | PO BOX 297
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City | BOYDTON
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State | VA
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Zip | 23917-0297
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Country | US
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Telephone | 434-738-6911
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Fax | 434-738-0431
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLOUGHBY SHELTON HUNDLEY III
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Credential | MD
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Telephone | 434-738-6911
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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 |
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License Number State | VA
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