Organization
SOUTHSIDE MEDICAL ASSOCIATES P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERRY LENE HALL M.D (M.D)
(434) 575-6300
Entity
Organization
Contact information
Practice address
2202-A BEECHMONT ROAD, SOUTH BOSTON, VA 24592-2547
(434) 575-6300
(434) 575-8300
Mailing address
2202-A BEECHMONT ROAD, SOUTH BOSTON, VA 24592-2547
(434) 575-6300
(434) 575-8300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101023654
VA
207R00000X
Internal Medicine Physician
010141405
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005880769
—
VA
05
—
005880777
—
VA
01
—
110244239
RR MEDICARE
VA
01
—
110244240
RR MEDICARE
VA
01
—
20602
OPTIMA
—
01
—
44111
OPTIMA
—
Enumeration date
09/19/2006
Last updated
07/14/2009
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