Provider Demographics
NPI:1285212480
Name:SOUTHALL, CALEB DONALDSON (MD)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:DONALDSON
Last Name:SOUTHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13540 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5609 CLAIBORNE RD
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:VA
Practice Address - Zip Code:23885-9303
Practice Address - Country:US
Practice Address - Phone:804-265-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101283159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine