Organization
SOUTHSIDE FAMILY PRACTICE P.C.
Active
Other names
southside family practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIRLENE TOLBERT MOTEN M.D. (MEDICAL DIRECTOR)
(804) 733-3739
Entity
Organization
Contact information
Practice address
24 S ADAMS ST, PETERSBURG, VA 23803-4525
(804) 733-3739
(804) 722-0634
Mailing address
24 S ADAMS ST, PETERSBURG, VA 23803-4525
(804) 733-3739
(804) 722-0634
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101054986
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005637686
—
VA
Enumeration date
03/22/2007
Last updated
11/16/2008
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