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Organization
DVA VHA RICHMOND
Active
Organization
DVA VHA RICHMOND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNATHAN BRANTLEY DPM (PODIATRIST)
(804) 675-5000
Entity
Organization
Contact information
Practice address
1201 BROAD ROCK BLVD, RICHMOND, VA 23249-0001
(804) 675-5000
Mailing address
4112 WHITFORD CIR APT 206, GLEN ALLEN, VA 23060-4164
(516) 424-3745
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0116031054
VA
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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