Healthcare Provider Details

I. General information

NPI: 1114298775
Provider Name (Legal Business Name): JSA OF VIRGINIA - WOMENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

PO BOX 543
ALPHARETTA GA
30009-0543
US

V. Phone/Fax

Practice location:
  • Phone: 678-983-4479
  • Fax:
Mailing address:
  • Phone: 678-983-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: ANN H SCHAKER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 678-983-4479