Individual
CHARLES WAYNE MCDONOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6714 PATTERSON AVE STE 204, RICHMOND, VA 23226-3432
(804) 282-3387
Mailing address
9212 SHADY GROVE RD, MECHANICSVILLE, VA 23116-2845
(804) 873-9379
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024182163
VA
Other
Enumeration date
07/19/2021
Last updated
07/19/2021
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