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General NPI Number Information
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NPI Number | 1619184132
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Entity Type | Organization
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Legal Business Name | HEALTHY KIDS PEDIATRIC CENTER, P.C.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 44075 PIPELINE PLZ SUITE 210
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City | ASHBURN
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State | VA
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Zip | 20147-5881
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Country | US
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Telephone | 703-858-0121
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Fax | 703-858-0710
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Provider Business Mailing Address
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Address Line | 44075 PIPELINE PLZ SUITE 210
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City | ASHBURN
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State | VA
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Zip | 20147-5881
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Country | US
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Telephone | 703-858-0121
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Fax | 703-858-0710
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RESA E DAVIS
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Credential | M.D.
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Telephone | 703-858-0121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101234951
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License Number State | VA
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