Organization
DOMINION HEALTH MEDICAL ASSOC
Active
Other names
Sentara Halifax Neurology
Organization subpart
No
Provider details
NPI number
Authorized official
CECIL HAZELWOOD (MANAGER (SDHG))
(434) 517-3515
Entity
Organization
Contact information
Practice address
2206 WILBORN AVE, SOUTH BOSTON, VA 24592
(434) 517-8075
(434) 517-3887
Mailing address
P.O. BOX 860, SOUTH BOSTON, VA 24592
(434) 517-3513
(434) 517-3887
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0101251410
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101251410
LICENSE
VA
Enumeration date
04/30/2012
Last updated
02/10/2015
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