Organization
DOMINION HEALTH MEDICAL ASSOC.
Active
Other names
Sentara Volens Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
CECIL HAZELWOOD (MANAGER SDHG)
(434) 517-3590
Entity
Organization
Contact information
Practice address
15210 L. P. BAILEY MEMORIAL HWY, SOUTH BOSTON, VA 24592
(434) 349-3113
(434) 517-3887
Mailing address
P.O. BOX 860, SOUTH BOSTON, VA 24592
(434) 517-3513
(434) 517-3887
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
0101032102
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007610661
—
VA
Enumeration date
10/02/2006
Last updated
02/10/2015
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