Healthcare Provider Details

I. General information

NPI: 1588740161
Provider Name (Legal Business Name): FAIRFAX FAMILY PRACTICE CENTERS, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ARLINGTON BLVD SUITE 405
FAIRFAX VA
22031-2902
US

IV. Provider business mailing address

PO BOX 791128
BALTIMORE MD
21279-1128
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-9000
  • Fax: 703-698-6901
Mailing address:
  • Phone: 703-391-2030
  • Fax: 703-273-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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