Healthcare Provider Details

I. General information

NPI: 1710702154
Provider Name (Legal Business Name): JMV ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BERKMAR CIR
CHARLOTTESVILLE VA
22901-1464
US

IV. Provider business mailing address

631 BERKMAR CIR
CHARLOTTESVILLE VA
22901-1464
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-9133
  • Fax: 804-282-9135
Mailing address:
  • Phone: 804-282-9133
  • Fax: 804-282-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NOEL B JEWELL
Title or Position: MEMBER PRESIDENT
Credential: MD
Phone: 304-647-4019