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General NPI Number Information
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NPI Number | 1427718154
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Entity Type | Organization
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Legal Business Name | AT HOME MD LLC
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 1123 E STUART DR
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City | GALAX
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State | VA
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Zip | 24333-2513
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Country | US
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Telephone | 276-266-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 E STUART DR
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City | GALAX
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State | VA
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Zip | 24333-2513
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Country | US
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Telephone | 276-266-3149
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRADLEY LINEBERRY
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Credential |
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Telephone | 276-266-3149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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