Provider Demographics
NPI:1831963123
Name:MARTINSVILLE PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:MARTINSVILLE PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:276-618-1128
Mailing Address - Street 1:410 LEES RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-0512
Mailing Address - Country:US
Mailing Address - Phone:276-618-1125
Mailing Address - Fax:
Practice Address - Street 1:22 E CHURCH ST STE 308
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-6208
Practice Address - Country:US
Practice Address - Phone:276-618-1125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health