Healthcare Provider Details

I. General information

NPI: 1689731234
Provider Name (Legal Business Name): DRS FARR WAMPLER HENSON & WILLIAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 SUDLEY ROAD #206
MANASSAS VA
20110
US

IV. Provider business mailing address

8650 SUDLEY ROAD #206
MANASSAS VA
20110
US

V. Phone/Fax

Practice location:
  • Phone: 703-368-9234
  • Fax: 703-368-0505
Mailing address:
  • Phone: 703-368-9234
  • Fax: 703-368-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101049560
License Number StateVA

VIII. Authorized Official

Name: JOSEPH G FARR
Title or Position: PRESIDENT
Credential: MD
Phone: 703-368-9234