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Individual

LACEY COLVIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
3700 S MAIN ST, BLACKSBURG, VA 24060-7017
(850) 628-0877
Mailing address
2980 BAKER DR, VINTON, VA 24179-1602
(850) 628-0877

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0116030247
VA
207R00000X
Internal Medicine Physician
Primary
VA0116030247
VA

Other

Enumeration date
03/24/2017
Last updated
05/07/2020
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