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General NPI Number Information
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NPI Number | 1760589287
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE MEDICAL ASSOCIATES P.C
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 2202-A BEECHMONT ROAD
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2547
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Country | US
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Telephone | 434-575-6300
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Fax | 434-575-8300
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Provider Business Mailing Address
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Address Line | 2202-A BEECHMONT ROAD
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2547
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Country | US
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Telephone | 434-575-6300
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Fax | 434-575-8300
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Authorized Official
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Title or Position | M.D
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Name | DR. SHERRY LENE HALL
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Credential | M.D
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Telephone | 434-575-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 010141405
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101023654
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License Number State | VA
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