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General NPI Number Information
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NPI Number | 1730834326
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Entity Type | Organization
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Legal Business Name | PHOENIX MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/13/2022
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 11357 NUCKOLS RD # 2091
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5504
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Country | US
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Telephone | 804-624-9917
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Fax | 804-729-5887
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Provider Business Mailing Address
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Address Line | 11357 NUCKOLS RD # 2091
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5504
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Country | US
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Telephone | 804-965-4327
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Fax | 804-729-5887
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Authorized Official
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Title or Position | DNP, PMHNP-BC
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Name | MISS DEBORAH CRUTCHFIELD
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Credential |
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Telephone | 804-965-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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