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General NPI Number Information
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NPI Number | 1295169605
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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 | 08/22/2013
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 14540 JOHN MARSHALL HWY SUITE 104
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City | GAINESVILLE
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State | VA
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Zip | 20155-1691
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Country | US
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Telephone | 703-753-9799
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Fax | 703-753-9792
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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 | 703-753-9799
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Fax |
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | GEOFFREY GARDNER
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Credential |
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Telephone | 703-753-9799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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