Individual
TINA SMITH GATEWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
705 MAIN ST, DANVILLE, VA 24541-1803
(434) 791-4123
(434) 791-4126
Mailing address
159 EXECUTIVE DR, SUITE E, DANVILLE, VA 24541-4160
(434) 791-2629
(434) 791-2631
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102123
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1021947
NCCPA
—
01
—
910785
PA CERTIFICATION NUMBER
—
Enumeration date
07/01/2009
Last updated
06/10/2019
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