Organization
PEDIATRIC SPECIALISTS FOR CJW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL SMITH (VICE PRESIDENT)
(800) 661-3365
Entity
Organization
Contact information
Practice address
7157 JAHNKE RD, RICHMOND, VA 23225-4017
(804) 523-8061
(804) 523-8066
Mailing address
7157 JAHNKE RD, RICHMOND, VA 23225-4017
(804) 523-8061
(804) 523-8066
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215093703
—
VA
Enumeration date
12/29/2006
Last updated
07/21/2022
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