Healthcare Provider Details

I. General information

NPI: 1841383866
Provider Name (Legal Business Name): GRADY HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7524 DIPLOMAT DR
MANASSAS VA
20109-2685
US

IV. Provider business mailing address

PO BOX 2041
MANASSAS VA
20108-0815
US

V. Phone/Fax

Practice location:
  • Phone: 703-361-4357
  • Fax: 703-361-0346
Mailing address:
  • Phone: 703-361-4357
  • Fax: 703-361-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GERALD K LEE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 703-361-4357