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General NPI Number Information
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NPI Number | 1700627130
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Entity Type | Organization
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Legal Business Name | EVENTUS WH MID-ATLANTIC, LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 250 BROWNS HILL CT
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-9510
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Country | US
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Telephone | 855-743-2247
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1431 DEPT 405
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City | CHARLOTTE
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State | NC
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Zip | 28201-1431
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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 | BRADLEY GOAD
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Credential | DO
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Telephone | 855-743-2247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | 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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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