Provider Demographics
NPI:1033273354
Name:NORFOLK DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:NORFOLK DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:CHILD DEVELOPMENT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:757-683-2796
Mailing Address - Street 1:830 SOUTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1001
Mailing Address - Country:US
Mailing Address - Phone:757-683-2796
Mailing Address - Fax:757-683-8878
Practice Address - Street 1:830 SOUTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1001
Practice Address - Country:US
Practice Address - Phone:757-683-2796
Practice Address - Fax:757-683-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities