Provider Demographics
NPI:1396986063
Name:AKINS MEDICAL GROUP
Entity type:Organization
Organization Name:AKINS MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:AKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-399-7000
Mailing Address - Street 1:301 GOODE WAY
Mailing Address - Street 2:STE. 101
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2266
Mailing Address - Country:US
Mailing Address - Phone:757-399-7000
Mailing Address - Fax:757-399-5166
Practice Address - Street 1:301 GOODE WAY
Practice Address - Street 2:STE. 101
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2266
Practice Address - Country:US
Practice Address - Phone:757-399-7000
Practice Address - Fax:757-399-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6058132Medicaid
VA6058132Medicaid