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General NPI Number Information
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NPI Number | 1114414299
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Entity Type | Organization
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Legal Business Name | ALLIANCE FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 04/15/2018
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Last Update Date | 04/15/2018
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Provider Practice Location Address
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Address Line | 119 W BROOKLAND PARK BLVD
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City | RICHMOND
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State | VA
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Zip | 23222-2633
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Country | US
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Telephone | 804-304-6324
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Fax |
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Provider Business Mailing Address
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Address Line | 119 W BROOKLAND PARK BLVD
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City | RICHMOND
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State | VA
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Zip | 23222-2633
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Country | US
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Telephone | 804-304-6324
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | EVELYN HALL-HARRIS
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Credential | NP
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Telephone | 804-304-6324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0024131004
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License Number State | VA
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