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General NPI Number Information
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NPI Number | 1073752838
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Entity Type | Organization
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Legal Business Name | ADVANTAGE FAMILY CARE, P.C.
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 3105 AMERICAN LEGION RD STE A
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5653
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Country | US
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Telephone | 757-686-3999
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Fax | 757-686-3015
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Provider Business Mailing Address
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Address Line | 3105 AMERICAN LEGION RD STE A
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5653
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Country | US
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Telephone | 757-686-3999
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Fax | 757-686-3015
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LATANYA GRAY
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Credential | MD
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Telephone | 757-686-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101228019
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License Number State | VA
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