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Organization

PENINSULA KIDNEY ASSOCIATES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHAWANA L DAVIS (ADMINISTRATOR)
(757) 251-7469
Entity
Organization

Contact information

Practice address
501 BUTLER FARM RD, SUITE I, HAMPTON, VA 23666-1564
(757) 251-7469
(757) 251-7470
Mailing address
501 BUTLER FARM RD, SUITE I, HAMPTON, VA 23666-1777
(757) 251-7469
(757) 251-7470

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1750436531
VA
Enumeration date
01/24/2007
Last updated
06/02/2016
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