Individual
JAMES DETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11020 HULL STREET RD, MIDLOTHIAN, VA 23112-3200
(804) 744-6310
Mailing address
PO BOX 409540, ATLANTA, GA 30384-9540
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002348
VA
363A00000X
Physician Assistant
PENDING
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
TRICARE PROVIDER NUMBER
NC
Enumeration date
07/08/2006
Last updated
10/18/2021
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