Healthcare Provider Details

I. General information

NPI: 1013479682
Provider Name (Legal Business Name): NEW HEIGHTS PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8117 KINGS HWY
KING GEORGE VA
22485-7068
US

IV. Provider business mailing address

8117 KINGS HWY
KING GEORGE VA
22485-7068
US

V. Phone/Fax

Practice location:
  • Phone: 540-441-0640
  • Fax:
Mailing address:
  • Phone: 540-441-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AYANNA J MCCRAY
Title or Position: MD
Credential: MD
Phone: 540-441-0640