Provider Demographics
NPI:1003381310
Name:TOWNES, AUDREY R
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:R
Last Name:TOWNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15531 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2911
Mailing Address - Country:US
Mailing Address - Phone:804-201-0408
Mailing Address - Fax:804-918-6723
Practice Address - Street 1:837 AZALEA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3512
Practice Address - Country:US
Practice Address - Phone:804-201-0408
Practice Address - Fax:804-918-6723
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization