Organization
PROVIDENCE FAMILY & SPORTS MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA CAMPBELL WOOD (OFFICE MANAGER)
(434) 791-4110
Entity
Organization
Contact information
Practice address
173 EXECUTIVE DR, DANVILLE, VA 24541-4101
(434) 791-4110
(434) 791-4003
Mailing address
173 EXECUTIVE DR, DANVILLE, VA 24541-4101
(434) 791-4110
(434) 791-4003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053403378
NPI
—
Enumeration date
09/28/2006
Last updated
05/26/2022
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