Healthcare Provider Details

I. General information

NPI: 1891854014
Provider Name (Legal Business Name): AHC KENNER-FT GREGG-ADAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH ST
FORT LEE VA
23801-1716
US

IV. Provider business mailing address

700 24TH ST ATTN PAD
FORT LEE VA
23801-1716
US

V. Phone/Fax

Practice location:
  • Phone: 804-734-9000
  • Fax:
Mailing address:
  • Phone: 804-734-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAYA HARR
Title or Position: UBO MANAGER
Credential:
Phone: 804-734-9373