Organization
SOUTHSIDE OB-GYN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY LOUIS TOMLIN M.D. (PRESIDENT)
(804) 732-0136
Entity
Organization
Contact information
Practice address
600 S SYCAMORE ST, PETERSBURG, VA 23803-5815
(804) 732-0136
(804) 861-9661
Mailing address
600 S SYCAMORE ST, PETERSBURG, VA 23803-5815
(804) 732-0136
(804) 861-9661
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101029081
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070725
ANTHEM
VA
01
—
212033
CIGNA
VA
01
—
213198
MDIPA OPTIMUM CHOICE
VA
Enumeration date
05/08/2007
Last updated
04/20/2008
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