Healthcare Provider Details

I. General information

NPI: 1609938232
Provider Name (Legal Business Name): GIVFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 WILLIAMS DR STE 300
FAIRFAX VA
22031-4623
US

IV. Provider business mailing address

3015 WILLIAMS DR STE 300
FAIRFAX VA
22031-4623
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-1971
  • Fax: 703-995-0461
Mailing address:
  • Phone: 703-289-1971
  • Fax: 703-995-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0207X
TaxonomyMedical Biochemical Genetics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number19D0221993
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number49D0886517
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHICQUITA JOHNSON
Title or Position: BUSINESS OFFICE FINANCIAL MANAGER
Credential:
Phone: 703-289-1971