Organization
SOUTHERN WV MEDICAL AND SURGICAL SPECIALISTS PLLC
Active
Other names
Southern WV ENT
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN WAYNE DOUGLAS M.D. (OWNER/PRESIDENT)
(304) 929-6930
Entity
Organization
Contact information
Practice address
206 SKYLAR DR, LEWISBURG, WV 24901-9383
(681) 318-3540
(877) 712-1319
Mailing address
PO BOX 5482, BECKLEY, WV 25801-7506
(304) 929-6930
(304) 929-6935
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
23770
WV
Other
Enumeration date
06/01/2016
Last updated
06/22/2016
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