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Organization
SOUTHSIDE FAMILY PRACTICE P.C.
Active
Organization
SOUTHSIDE FAMILY PRACTICE P.C.
Active
Other names
southside family practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIRLENE TOLBERT MOTEN M.D. (MEDICAL DIRECTOR)
(804) 733-3739
Entity
Organization
Contact information
Practice address
24 S ADAMS ST, PETERSBURG, VA 23803-4525
(804) 733-3739
(804) 722-0634
Mailing address
24 S ADAMS ST, PETERSBURG, VA 23803-4525
(804) 733-3739
(804) 722-0634
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101054986
VA
Other
Enumeration date
03/22/2007
Last updated
11/16/2008
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