Organization
FULLER-ROBERTS CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTY NEWTON II (OFFICE MANAGER)
(434) 572-8921
Entity
Organization
Contact information
Practice address
2212 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 572-8921
(434) 572-2063
Mailing address
2212 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 572-8921
(434) 572-2063
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407891815
—
VA
Enumeration date
06/19/2006
Last updated
08/21/2014
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