Organization
SOUTHERN PHYSICAL MEDICINE ASSOCIATES INC
Active
Other names
Physical Medicine Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES H BONNER SR. (PRESIDENT)
(804) 282-6593
Entity
Organization
Contact information
Practice address
5922 W BROAD ST, RICHMOND, VA 23230-2231
(804) 282-6593
(804) 282-8215
Mailing address
5922 W BROAD ST, RICHMOND, VA 23230-2231
(804) 282-6953
(804) 282-8215
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0715002791
VA
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
0101032689
VA
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
0101032689
VA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0101032689
VA
2081P0004X
Spinal Cord Injury Medicine Physician
0101032689
VA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
0101032689
VA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
0101032689
VA
208VP0014X
Interventional Pain Medicine Physician
0101032689
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066834400
—
VA
Enumeration date
05/22/2007
Last updated
07/31/2012
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