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General NPI Number Information
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NPI Number | 1245789460
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Entity Type | Organization
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Legal Business Name | NOVA ADDICTION SPECIALISTS LLLC
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 101 N COLUMBUS ST SUITE 405
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3056
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Country | US
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Telephone | 703-340-1304
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Fax | 888-965-7708
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Provider Business Mailing Address
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Address Line | 101 N COLUMBUS ST SUITE 405
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3056
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Country | US
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Telephone | 703-340-1304
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Fax | 888-965-7708
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MICHAEL HOMEYER
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Credential | MD
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Telephone | 703-340-1304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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