Healthcare Provider Details

I. General information

NPI: 1174436489
Provider Name (Legal Business Name): MCKENZIE DELOS JAMISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SHIRLINGTON RD STE 1100
ARLINGTON VA
22206-3605
US

IV. Provider business mailing address

163 MASTERS WAY
GRASONVILLE MD
21638-1417
US

V. Phone/Fax

Practice location:
  • Phone: 703-892-6500
  • Fax:
Mailing address:
  • Phone: 202-406-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0110012409
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: