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General NPI Number Information
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NPI Number | 1821527516
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Entity Type | Individual
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Provider Name | THERESE PODGORSKI NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 7101 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4017
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Country | US
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Telephone | 855-863-9595
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Fax | 706-868-8375
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Provider Business Mailing Address
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Address Line | PO BOX 3548
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City | AUGUSTA
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State | GA
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Zip | 30914-3548
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Country | US
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Telephone | 855-863-9595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0024174380
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001215627
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License Number State | VA
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