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General NPI Number Information
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NPI Number | 1831196872
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Entity Type | Organization
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Legal Business Name | WILLIAMSBURG NEUROLOGY, P.C.
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 120 KINGS WAY SUITE 2700
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2505
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Country | US
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Telephone | 757-221-0110
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Fax | 757-221-0851
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Provider Business Mailing Address
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Address Line | 120 KINGS WAY SUITE 2700
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2505
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Country | US
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Telephone | 757-221-0110
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Fax | 757-221-0851
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Authorized Official
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Title or Position | MEDICAL PRACTICE ADMINISTRATOR
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Name | MR. SHAWN M. BRAINARD
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Credential | MBA
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Telephone | 757-345-3907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101048000
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101052740
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License Number State | VA
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