| Organization Name: | DOMINION HEALTH MEDICAL ASSOC |
| NPI Number: | 1134407570 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CECIL HAZELWOOD (MANAGER DHMA) |
| Mailing Address: | 2204 Wilborn Ave South Boston |
| State: | VA US |
| Postal Code: | 24592 |
| Phone Number: | 4345173529 |
| Fax Number: | 4345173887 |
| NPI Enumeration Date: | 08/03/2011 |
| NPI Last Update Date: | 02/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Emergency Care |
| Taxonomy Definition: | |