Organization
FAMILY PRACTICE AT RETREAT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL SMITH (VP)
(804) 254-9807
Entity
Organization
Contact information
Practice address
110 N ROBINSON ST, SUITE 203, RICHMOND, VA 23220-4459
(804) 254-9807
(804) 254-9792
Mailing address
110 N ROBINSON ST, SUITE 203, RICHMOND, VA 23220-4459
(804) 254-9807
(804) 254-9792
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629019492
—
VA
Enumeration date
06/10/2006
Last updated
01/04/2008
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