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General NPI Number Information
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NPI Number | 1255751228
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Entity Type | Organization
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Legal Business Name | PINNACLE FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 13135 LEE JACKSON MEMORIAL HWY STE 202
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City | FAIRFAX
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State | VA
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Zip | 22033-1907
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Country | US
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Telephone | 703-965-3168
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Fax | 703-000-0000
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Provider Business Mailing Address
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Address Line | 13135 LEE JACKSON MEMORIAL HWY STE 202
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City | FAIRFAX
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State | VA
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Zip | 22033-1907
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Country | US
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Telephone | 703-965-3168
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Fax | 703-000-0000
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. VANESSA BILLSTONE PEYTON
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Credential | MD
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Telephone | 703-965-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101221501
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License Number State | VA
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