Individual
GEORGICA RYNESHA BASKERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2683 BRODNAX RD, BRODNAX, VA 23920-2821
(434) 247-1562
(434) 636-5831
Mailing address
2683 BRODNAX RD, BRODNAX, VA 23920-2821
(434) 247-1562
(434) 636-5831
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
VA
Other
Enumeration date
07/26/2017
Last updated
07/21/2022
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