NPI 1699488494

A Family Is Eternal

Organisation Exclusive Provider Organization Petersburg, VA

Practice location

Address: 1889 S Sycamore St, Petersburg, VA 23805-2730
Phone: (804) 605-9845
Fax: (804) 895-7853

Authorised official

Name: Nita Viann Randolph Davison
Title: Manager
Phone: (804) 552-1397

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1699488494
Entity type: Organization
NPI issued: 27 Dec 2022
Record last updated: 27 Dec 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.