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General NPI Number Information
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NPI Number | 1689854846
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Entity Type | Organization
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Legal Business Name | GUEDON MEDICAL CLINIC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 98 15TH ST NW
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City | NORTON
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State | VA
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Zip | 24273-1600
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Country | US
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Telephone | 540-446-2278
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Fax | 804-545-3959
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Provider Business Mailing Address
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Address Line | 98 15TH ST NW
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City | NORTON
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State | VA
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Zip | 24273-1600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLIVETTE GUEDON
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Credential | MD
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Telephone | 540-446-2278
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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 | 0101221402
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License Number State | VA
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