Southside Family Practice P.c.
NPI #1780700765 in Petersburg, Virginia
Provider Information
- NPI Number
- 1780700765
- Entity Type
- Organization
- Organization Name
- Southside Family Practice P.c.
- Primary Specialty
- Family Medicine
- Enumeration Date
- Mar 22, 2007
- Last Updated
- Nov 16, 2008
Practice Location
- Address
- 24 S ADAMS ST
- City
- Petersburg
- State
- Virginia
- ZIP Code
- 23803-4525
- Phone
- (804) 733-3739
Authorized Official
- Name
- DR. SHIRLENE TOLBERT MOTEN, M.D.
- Title
- MEDICAL DIRECTOR
- Phone
- (804) 733-3739
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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