=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609938232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIVFF LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3015 WILLIAMS DR STE 300
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-289-1971
-----------------------------------------------------
Fax | 703-995-0461
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3015 WILLIAMS DR STE 300
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-289-1971
-----------------------------------------------------
Fax | 703-995-0461
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE FINANCIAL MANAGER
-----------------------------------------------------
Name | CHICQUITA JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-289-1971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207SG0207X
-----------------------------------------------------
Taxonomy Name | Medical Biochemical Genetics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 19D0221993
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 49D0886517
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------