Individual
DR. CLARENCE G. CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10150 STAPLES MILL RD, SUITE E, GLEN ALLEN, VA 23060-3452
(804) 755-7581
(804) 755-7586
Mailing address
10150 STAPLES MILL RD, SUITE E, GLEN ALLEN, VA 23060-3452
(804) 755-7581
(804) 755-7586
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101056147
VA
207RI0200X
Infectious Disease Physician
Primary
0101056147
VA
208000000X
Pediatrics Physician
0101056147
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010012759
—
VA
01
—
C06115
GROUP PTAN
VA
Enumeration date
10/13/2006
Last updated
07/11/2012
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