# LIBERTY MOUNTAIN MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRAL VIRGINIA FAMILY PHYSICIANS, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043602840
- **Legal business name:** CENTRAL VIRGINIA FAMILY PHYSICIANS, INC.
- **Authorized official:** KAREN L HAYNES (STAFF CREDENTIALING MANAGER)
- **Authorized official phone:** (434) 382-1139

## Contact information

- **Practice address:** 2321 WARDS RD, LYNCHBURG, VA 24502-2101
- **Practice address phone:** (434) 582-2273
- **Practice address fax:** (434) 582-1363
- **Mailing address:** 2321 WARDS RD, LYNCHBURG, VA 24502-2101
- **Mailing address phone:** (434) 582-2273
- **Mailing address fax:** (434) 582-1363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/03/2015
- **Last updated:** 03/30/2016