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General NPI Number Information
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NPI Number | 1477934727
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Entity Type | Organization
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Legal Business Name | POTOMAC HEALTHCARE SOLUTIONS, LLC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 1549 OLD BRIDGE RD STE 201
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2737
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Country | US
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Telephone | 703-498-2773
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Fax | 703-542-1772
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Provider Business Mailing Address
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Address Line | 1549 OLD BRIDGE RD STE 201
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2737
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Country | US
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Telephone | 703-498-2773
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Fax | 703-542-1772
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DAPHNEY JACKSON
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Credential |
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Telephone | 703-498-2773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | S4081867
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | S4081867
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License Number State | VA
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