Healthcare Provider Details

I. General information

NPI: 1962561118
Provider Name (Legal Business Name): JAMES ANDREW CHURCH FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 NEW GUINEA RD
FT. STORY VA
23459
US

IV. Provider business mailing address

741 LEYTE CIRCLE
FT. STORY VA
23459
US

V. Phone/Fax

Practice location:
  • Phone: 757-422-7822
  • Fax: 757-422-7839
Mailing address:
  • Phone: 757-473-1055
  • Fax: 757-422-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN069097
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: