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General NPI Number Information
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NPI Number | 1740229608
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Entity Type | Organization
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Legal Business Name | CHIPPENHAM AND JOHNSTON-WILLIS SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 1115 BOULDERS PKWY STE 110
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23225-4067
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Country | US
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Telephone | 804-560-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 HEALTH PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4692
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Country | US
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Telephone | 615-373-7406
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SUZANNE BERGAMO
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Credential |
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Telephone | 804-267-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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