Healthcare Provider Details

I. General information

NPI: 1336171164
Provider Name (Legal Business Name): DIRECTOR OF FINANCE-COUNTY OF FAIRFAX VA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 MAIN ST SUITE 202
FAIRFAX VA
22030-6903
US

IV. Provider business mailing address

12000 GOVERNMENT CENTER PKWY SUITE 552
FAIRFAX VA
22035-0001
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-8695
  • Fax:
Mailing address:
  • Phone: 703-324-3360
  • Fax: 703-324-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. ANTHONY GRIFFIN
Title or Position: COUNTY EXECUTIVE
Credential:
Phone: 703-324-3360