Provider Demographics
NPI:1265288500
Name:BRISCO, JOHN CURLY III (DOCTOR)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CURLY
Last Name:BRISCO
Suffix:III
Gender:M
Credentials:DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-6906
Mailing Address - Country:US
Mailing Address - Phone:804-439-1212
Mailing Address - Fax:
Practice Address - Street 1:49 S MARKET ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4214
Practice Address - Country:US
Practice Address - Phone:804-439-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103445101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty