Healthcare Provider Details

I. General information

NPI: 1770404162
Provider Name (Legal Business Name): GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 COMMISSION CT
WOODBRIDGE VA
22192-1784
US

IV. Provider business mailing address

3350 COMMISSION CT
WOODBRIDGE VA
22192-1784
US

V. Phone/Fax

Practice location:
  • Phone: 703-680-7950
  • Fax:
Mailing address:
  • Phone: 703-680-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN OTIS HARRIS
Title or Position: CEO
Credential:
Phone: 661-381-0458