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General NPI Number Information
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NPI Number | 1922122605
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Entity Type | Organization
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Legal Business Name | LYNCHBURG RHEUMATOLOGY CLINIC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2025 TATE SPRINGS RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-1116
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Country | US
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Telephone | 434-947-5918
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Fax | 434-947-5923
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Provider Business Mailing Address
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Address Line | 2025 TATE SPRINGS RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-1116
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Country | US
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Telephone | 434-947-5918
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Fax | 434-947-5923
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JEFFREY WELLINGTON WILSON
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Credential | M.D.
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Telephone | 434-947-5918
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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 | 0101030315
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License Number State | VA
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