Provider Demographics
NPI:1811712359
Name:DIRECT WELLNESS RVA
Entity type:Organization
Organization Name:DIRECT WELLNESS RVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:BEERS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:804-924-9400
Mailing Address - Street 1:2342 COLONY CROSSING PL STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4280
Mailing Address - Country:US
Mailing Address - Phone:804-924-9400
Mailing Address - Fax:804-924-7503
Practice Address - Street 1:2342 COLONY CROSSING PL STE A
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4280
Practice Address - Country:US
Practice Address - Phone:804-924-9400
Practice Address - Fax:804-924-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty