Healthcare Provider Details

I. General information

NPI: 1942390018
Provider Name (Legal Business Name): SAADIYA R. JACKSON-OWENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6358 SPRINGFIELD PLZ
SPRINGFIELD VA
22150-3431
US

IV. Provider business mailing address

4850 EISENHOWER AVE APT 220
ALEXANDRIA VA
22304-7322
US

V. Phone/Fax

Practice location:
  • Phone: 703-644-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101264591
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD036324
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: