Providence Family & Sports Medicine, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDENCE FAMILY & SPORTS MEDICINE, INC

Practice address

173 Executive Dr
Danville, VA 24541-4101

Phone

(434) 791-4110

Fax

(434) 791-4003

NPI assigned

Sep 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lisa Campbell Wood

Title

Office Manager

Phone

(434) 791-4110

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1053403378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 EXECUTIVE DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245414101",
            "telephone_number": "434-791-4110",
            "fax_number": "434-791-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 EXECUTIVE DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245414101",
            "telephone_number": "434-791-4110",
            "fax_number": "434-791-4003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "441 Piney Forest Rd",
            "address_2": "SUITE E",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "VA",
            "postal_code": "245404154",
            "country_code": "US",
            "telephone_number": "434-791-4110",
            "fax_number": "434-791-4003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE FAMILY & SPORTS MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "CAMPBELL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "434-791-4110",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1053403378",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Professional Pharmacy of Danville
• Professional Pharmacy, Inc.
• Professional Therapies of Roanoke, Inc.
• Profound Performance LLC
• Proverbs Medical and Health Clinic, LLC
• Cynthia Pruitt-Rhodes, LPC
• Carla-Marie Agee Pruitt, LCSW
• Latavia Prunty, BT
• Amanda Jones Pulley, DNP, FNP-C
• Rachel Brinkley Pullin, DDS

• Family Medicine Physician in Danville, VA
• Providers in Danville, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.