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General NPI Number Information
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NPI Number | 1568651719
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE AREA FAMILY MEDICINE INC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 324 COMMERCE RD
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City | FARMVILLE
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State | VA
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Zip | 23901-2794
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Country | US
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Telephone | 434-392-9366
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Fax | 434-392-9348
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Provider Business Mailing Address
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Address Line | 324 COMMERCE RD
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City | FARMVILLE
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State | VA
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Zip | 23901-2794
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Country | US
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Telephone | 434-392-9366
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Fax | 434-392-9348
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. TIMOTHY WILEY CORBETT SR.
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Credential | MD
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Telephone | 434-392-9366
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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 | 0101057605
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License Number State | VA
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