Healthcare Provider Details

I. General information

NPI: 1801776539
Provider Name (Legal Business Name): RENEE'S MEDICAL CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 COUNTRY WALK CIR
CARROLLTON VA
23314-3489
US

IV. Provider business mailing address

13350 COUNTRY WALK CIR
CARROLLTON VA
23314-3489
US

V. Phone/Fax

Practice location:
  • Phone: 757-675-8752
  • Fax:
Mailing address:
  • Phone: 757-675-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RENEE WINSTON DIAL
Title or Position: MANAGER/OWNER
Credential:
Phone: 757-675-8752