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General NPI Number Information
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NPI Number | 1881700946
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Entity Type | Organization
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Legal Business Name | SOUTHAMPTON PRIMARY CARE
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 102 FAIRVIEW DR SUITE F
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City | FRANKLIN
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State | VA
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Zip | 23851
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Country | US
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Telephone | 757-562-1421
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Fax | 757-562-1423
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Provider Business Mailing Address
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Address Line | P.O. BOX 26
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City | FRANKLIN
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State | VA
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Zip | 23851
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Country | US
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Telephone | 757-562-1421
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Fax | 757-562-1423
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ITRISH JOUBY SCOTT-BROWN
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Credential | M.D.
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Telephone | 757-562-1421
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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 | 0101232415
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License Number State | VA
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