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Organization

GYN CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHAKKRIS SIRI M.D., F.A.C.O.G. (OWNER)
(804) 526-7229
Entity
Organization

Contact information

Practice address
648 SOUTHPARK BLVD, SUITE C, COLONIAL HEIGHTS, VA 23834-3632
(804) 526-7229
(804) 526-6007
Mailing address
648 SOUTHPARK BLVD, SUITE C, COLONIAL HEIGHTS, VA 23834-3632
(804) 526-7229
(804) 526-6007

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101031880
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0101031880
STATE LICENSE NUMBER
VA
Enumeration date
06/18/2014
Last updated
06/18/2014
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