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General NPI Number Information
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NPI Number | 1154701878
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Entity Type | Organization
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Legal Business Name | NMG AFFILIATE PRACTICE I, LLC
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 8567 SUDLEY RD STE B
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City | MANASSAS
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State | VA
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Zip | 20110-3865
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Country | US
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Telephone | 703-369-5959
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Fax | 703-369-7473
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 703-369-5959
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Fax | 703-369-7473
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | GEOFFERY K GARDNER
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Credential |
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Telephone | 704-384-7606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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