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General NPI Number Information
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NPI Number | 1609386556
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Entity Type | Organization
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Legal Business Name | VA COMMUNITY HEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 8180 STONEWALL SHOPS SQ
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City | GAINESVILLE
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State | VA
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Zip | 20155
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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 748613
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City | ATLANTA
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State | GA
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Zip | 30384-8613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CHUCK D. CODER
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Credential |
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Telephone | 804-835-2069
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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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