Healthcare Provider Details

I. General information

NPI: 1649078833
Provider Name (Legal Business Name): SAFETY NET DATA ADVISORS' INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4486 OAKDALE CRESCENT CT APT 4111
FAIRFAX VA
22030-6753
US

IV. Provider business mailing address

4486 OAKDALE CRESCENT CT APT 4111
FAIRFAX VA
22030-6753
US

V. Phone/Fax

Practice location:
  • Phone: 703-559-5487
  • Fax:
Mailing address:
  • Phone: 703-559-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: JEREMY WILLIAMS SR.
Title or Position: CEO
Credential:
Phone: 202-754-5959