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Organization
DOMINION HEALTH MEDICAL ASSOC
Active
Organization
DOMINION HEALTH MEDICAL ASSOC
Active
Other names
Sentara Halifax Emergency Physicial
Organization subpart
No
Provider details
NPI number
Authorized official
CECIL HAZELWOOD (MANAGER DHMA)
(434) 517-3515
Entity
Organization
Contact information
Practice address
2204 WILBORN AVE, SOUTH BOSTON, VA 24592
(434) 517-3529
(434) 517-3887
Mailing address
P.O. BOX 860, SOUTH BOSTON, VA 24592
(434) 517-3513
(434) 517-3887
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/03/2011
Last updated
02/10/2015
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