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General NPI Number Information
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NPI Number | 1245419159
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Entity Type | Individual
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Provider Name | KINDA NILAJA VENNER-JONES MD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 14605 POTOMAC BRANCH DR STE 210
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3337
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Country | US
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Telephone | 703-780-9014
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Fax | 703-780-9077
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Provider Business Mailing Address
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Address Line | 14605 POTOMAC BRANCH DR STE 210
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3337
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Country | US
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Telephone | 703-780-9014
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Fax | 703-780-9077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TMP-02520
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License Number State | WV
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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 | 0101254775
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License Number State | VA
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