Organization
WEIGHT LOSS SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAWN JOYNER (OFFICE MANAGER)
(757) 591-9572
Entity
Organization
Contact information
Practice address
645 J CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1819
(757) 591-9572
(757) 591-9606
Mailing address
645 J CLYDE MORRIS BLVD, NEWPORT NEWS, VA 23601-1819
(757) 591-9572
(757) 591-9606
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101050712
VA
174400000X
Specialist
0101236493
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138438
ANTHEM DR. TERRACINA
VA
01
—
453810
ANTHEM DR. THOMAS CLARK
VA
05
—
7312059
—
VA
Enumeration date
12/21/2006
Last updated
08/22/2020
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