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General NPI Number Information
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NPI Number | 1477048973
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Entity Type | Organization
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Legal Business Name | PTC WELLNESS CENTERS BWXT
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 1570 MT. ATHOS RD.
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City | LYNCHBURG
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State | VA
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Zip | 24504
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Country | US
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Telephone | 434-522-5006
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Fax | 434-522-5991
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Provider Business Mailing Address
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Address Line | PO BOX 785 MAIL STOP 66
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City | LYNCHBURG
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State | VA
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Zip | 24505
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Country | US
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Telephone | 434-522-5006
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Fax | 434-522-5991
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW TATOM
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Credential | D.O.
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Telephone | 434-455-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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