Dominion Health Medical Assoc
NPI #1760740625 in South Boston, Virginia
Provider Information
- NPI Number
- 1760740625
- Entity Type
- Organization
- Organization Name
- Dominion Health Medical Assoc
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Apr 30, 2012
- Last Updated
- Feb 10, 2015
Practice Location
- Address
- 2206 WILBORN AVE
- City
- South Boston
- State
- Virginia
- ZIP Code
- 24592
- Phone
- (434) 517-8075
Authorized Official
- Name
- CECIL HAZELWOOD
- Title
- MANAGER (SDHG)
- Phone
- (434) 517-3515
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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