Provider Demographics
NPI:1770073256
Name:GODOCS SOUTH BOSTON, LLC
Entity type:Organization
Organization Name:GODOCS SOUTH BOSTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGGINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-857-2114
Mailing Address - Street 1:3130 HALIFAX RD STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-4948
Mailing Address - Country:US
Mailing Address - Phone:434-857-2114
Mailing Address - Fax:434-835-4875
Practice Address - Street 1:3130 HALIFAX RD STE C
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4948
Practice Address - Country:US
Practice Address - Phone:434-857-2114
Practice Address - Fax:434-835-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201590208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty