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General NPI Number Information
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NPI Number | 1770613044
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Entity Type | Organization
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Legal Business Name | RETREAT CARDIOLOGY LLC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 505 W LEIGH ST SUITE 205
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City | RICHMOND
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State | VA
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Zip | 23220-3239
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Country | US
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Telephone | 804-788-0004
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Fax | 804-643-5935
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Provider Business Mailing Address
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Address Line | 505 W LEIGH ST SUITE 205
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City | RICHMOND
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State | VA
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Zip | 23220-3239
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Country | US
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Telephone | 804-788-0004
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Fax | 804-643-5935
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Authorized Official
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Title or Position | VP
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Name | WILLIAM TEDRICK JOHNSON
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Credential |
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Telephone | 804-237-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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