Healthcare Provider Details

I. General information

NPI: 1386053502
Provider Name (Legal Business Name): UVA COMMUNITY HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8644 SUDLEY RD SUITE 315
MANASSAS VA
20110-4417
US

IV. Provider business mailing address

PO BOX 748613
ATLANTA GA
30384-8613
US

V. Phone/Fax

Practice location:
  • Phone: 703-369-8055
  • Fax: 703-369-8565
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHARLES D. CODER
Title or Position: CFO
Credential:
Phone: 804-835-2069