Individual
ANTHONY L MCKINNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21410 DEODORA DR, SOUTH CHESTERFIELD, VA 23803-2278
(804) 349-9103
Mailing address
21410 DEODORA DR, SOUTH CHESTERFIELD, VA 23803-2278
(804) 349-9103
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EIN
TRANSPORTATION
VA
Enumeration date
07/14/2021
Last updated
07/14/2021
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