MEDICARE: CHIPPENHAM AND JOHNSTON-WILLIS SPORTS MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1740229608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIPPENHAM AND JOHNSTON-WILLIS SPORTS MEDICINE, LLC

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4692
Country	:	US
Telephone Number	:	615-373-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 BOULDERS PKWY STE 110
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-4067
Country	:	US
Telephone Number	:	804-560-6500
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	SUZANNE BERGAMO
Credential	:
Telephone Number	:	804-267-5950

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/20/2025

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