# CENTRA MEDICAL GROUP, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRA MEDICAL GROUP, LLC
- **Other names:** CMG Pediatric Endocrinology Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821690199
- **Legal business name:** CENTRA MEDICAL GROUP, LLC
- **Authorized official:** SONYA R T DAVIS (DIRECTOR REVENUE CYCLE)
- **Authorized official phone:** (434) 200-6942

## Contact information

- **Practice address:** 3300 RIVERMONT AVE, LYNCHBURG, VA 24503-2030
- **Practice address phone:** (434) 200-5933
- **Practice address fax:** (434) 200-4553
- **Mailing address:** 1937 THOMSON DR, LYNCHBURG, VA 24501-1008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/12/2020
- **Last updated:** 11/20/2020