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General NPI Number Information
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NPI Number | 1427591379
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Entity Type | Individual
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Provider Name | DARRELL JUSTIN RATCLIFFE PA -C
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Gender | Male
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Dates
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Enumeration Date | 11/27/2016
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 1500 W ACADEMY ST
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City | WINSTON SALEM
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State | NC
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Zip | 27103-3849
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Country | US
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Telephone | 540-461-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 14112 ASHMILL DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-1751
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Country | US
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Telephone | 540-461-0100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110-005780
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License Number State | VA
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