Provider Demographics
NPI:1568826246
Name:VIRGIL, DAVID II (AWC HEALTH EDUCATOR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VIRGIL
Suffix:II
Gender:M
Credentials:AWC HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 6TH AVENUE BUILDING 4102
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:334-255-3935
Mailing Address - Fax:
Practice Address - Street 1:2218 6TH AVENUE BUILDING 4102
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-3935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7248024391247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other