Provider Demographics
NPI:1457328767
Name:HUNDLEY, WILLOUGHBY SHELTON III (MD)
Entity Type:Individual
Prefix:
First Name:WILLOUGHBY
Middle Name:SHELTON
Last Name:HUNDLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917-0297
Mailing Address - Country:US
Mailing Address - Phone:434-738-6911
Mailing Address - Fax:434-738-0431
Practice Address - Street 1:969 MADISON STREET
Practice Address - Street 2:SUITE/BOX 297
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917
Practice Address - Country:US
Practice Address - Phone:434-738-6911
Practice Address - Fax:434-738-0431
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034527207P00000X, 207Q00000X
NC9801679207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI265659OtherANTHEM
VA5644810Medicaid
VA5644810Medicaid
VAB10004Medicare UPIN