Organization
CENTRA MEDICAL GROUP, LLC
Active
Parent organization
CENTRA MEDICAL GROUP, LLC
Other names
CMG Southside Pediatric Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRA MEDICAL GROUP, LLC
Authorized official
SONYA R T DAVIS (DIRECTOR REVENUE CYCLE)
(434) 200-6942
Entity
Organization
Contact information
Practice address
935 S MAIN ST, FARMVILLE, VA 23901-2211
(434) 315-5377
(434) 315-5923
Mailing address
PO BOX 829829, PHILADELPHIA, PA 19182-9829
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
02/11/2021
Last updated
02/11/2021
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