GYN Clinic, LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

0101031880 Issued in VA

Legal business name

GYN CLINIC, LLC

Practice address

648 Southpark Blvd
Suite C
Colonial Heights, VA 23834-3632

Phone

(804) 526-7229

Fax

(804) 526-6007

NPI assigned

Jun 18, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Chakkris Siri, M.D., F.A.C.O.G.

Title

Owner

Phone

(804) 526-7229

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1205240231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 SOUTHPARK BLVD",
            "address_2": "SUITE C",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238343632",
            "telephone_number": "804-526-7229",
            "fax_number": "804-526-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "648 SOUTHPARK BLVD",
            "address_2": "SUITE C",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238343632",
            "telephone_number": "804-526-7229",
            "fax_number": "804-526-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GYN CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-18",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "SIRI",
        "authorized_official_first_name": "CHAKKRIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-526-7229",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., F.A.C.O.G."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "VA",
            "license": "0101031880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "0101031880",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shantelle Gregory
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• Alicia Haase
• Audra L Hainer, PHARM.D.
• Shaun Hairston, DC
• Bernadette Wiley Hall, PT

• Obstetrics & Gynecology Physician in Colonial Heights, VA
• Providers in Colonial Heights, VA by specialty
• Obstetrics & Gynecology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.