Healthcare Provider Details

I. General information

NPI: 1801871165
Provider Name (Legal Business Name): JAMES B MIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15195 HEATHCOAT BLVD SUITE 338
HAYMARKET VA
20169-6244
US

IV. Provider business mailing address

PO BOX 748613
ATLANTA GA
30374-8613
US

V. Phone/Fax

Practice location:
  • Phone: 703-368-3161
  • Fax: 703-368-2498
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101230942
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: