# GYN CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205240231
- **Authorized official:** DR. CHAKKRIS SIRI M.D., F.A.C.O.G. (OWNER)
- **Authorized official phone:** (804) 526-7229

## Contact information

- **Practice address:** 648 SOUTHPARK BLVD, SUITE C, COLONIAL HEIGHTS, VA 23834-3632
- **Practice address phone:** (804) 526-7229
- **Practice address fax:** (804) 526-6007
- **Mailing address:** 648 SOUTHPARK BLVD, SUITE C, COLONIAL HEIGHTS, VA 23834-3632
- **Mailing address phone:** (804) 526-7229
- **Mailing address fax:** (804) 526-6007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 0101031880 | VA | Yes |

## Other

- **Enumeration date:** 06/18/2014
- **Last updated:** 06/18/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0101031880 | STATE LICENSE NUMBER | VA |