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General NPI Number Information
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NPI Number | 1639314370
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Entity Type | Organization
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Legal Business Name | SOUTH NORFOLK MEDICAL SERVICES,LLC
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 1201 JACKSON AVE
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City | CHESAPEAKE
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State | VA
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Zip | 23324-2307
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Country | US
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Telephone | 757-545-0425
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Fax | 757-545-0426
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Provider Business Mailing Address
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Address Line | 1201 JACKSON AVE
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City | CHESAPEAKE
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State | VA
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Zip | 23324-2307
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Country | US
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Telephone | 757-545-0425
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Fax | 757-545-0426
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Authorized Official
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Title or Position | PARTNER/ADMIN
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Name | MRS. SHIRLEY A STEPHENSON
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Credential |
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Telephone | 757-485-9870
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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 | 0101043479
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License Number State | VA
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