Childress, Clarence G.

Childress, Clarence G. is an individual health care provider with primary practice located at 10150 Staples Mill Rd Suite E, Glen Allen VA 23060-3452. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Infectious Disease, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Infectious Disease is his primary health care specialty. Childress, Clarence G. can be contacted via phone (804) 755-7581.

Contact Information

Primary practice address
10150 Staples Mill Rd Suite E Glen Allen VA 23060-3452
Phone: (804) 755-7581
Fax: (804) 755-7586
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 0101056147 Virginia
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X 0101056147 Virginia
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 0101056147 Virginia

Profile Details

NPI number 1902996549
LBN Legal business name Childress, Clarence G.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2006
Last updated Jul 11th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902996549 NPPES
Virginia MEDICAID 010012759
Virginia Other C06115

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