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General NPI Number Information
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NPI Number | 1578541520
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Entity Type | Organization
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Legal Business Name | USAMEDDAC FT EUSTIS VA
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | BLDG 2792 HARRISON LOOP PREVENTIVE MEDICINE
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City | FORT EUSTIS
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State | VA
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Zip | 23604
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Country | US
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Telephone | 757-878-4110
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Fax | 757-878-4533
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Provider Business Mailing Address
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Address Line | 128 KENILWORTH DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4025
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Country | US
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Telephone | 757-223-0653
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Fax |
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Authorized Official
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Title or Position | ARMY PUBLIC HEALTH NURSE
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Name | MR. GEORGE NORMAN WILLIAMS III
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Credential | BSN
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Telephone | 757-878-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | RN162229
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License Number State | GA
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