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General NPI Number Information
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NPI Number | 1972672731
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Entity Type | Organization
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Legal Business Name | LIFEWAY FAMILY PHYSICIANS PC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 1821 OLD DONATION PKWY SUITE #4
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3033
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Country | US
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Telephone | 757-496-4916
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Fax | 757-496-4046
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Provider Business Mailing Address
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Address Line | 1821 OLD DONATION PKWY SUITE #4
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3033
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Country | US
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Telephone | 757-496-4916
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Fax | 757-496-4046
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Authorized Official
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Title or Position | MANAGER
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Name | DEIRDRE BARNES
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Credential |
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Telephone | 757-496-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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