Healthcare Provider Details

I. General information

NPI: 1184748360
Provider Name (Legal Business Name): FAIRFAX FAMILY PRACTICE CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 PROFESSIONAL PLAZA SUITE 330
ASHBURN VA
20147
US

IV. Provider business mailing address

PO BOX 791128
BALTIMORE MD
21279-1128
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-0003
  • Fax: 703-726-6444
Mailing address:
  • Phone: 703-726-0003
  • Fax: 703-726-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES P JENKINS
Title or Position: PRESIDENT
Credential: MD
Phone: 703-255-9100