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General NPI Number Information
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NPI Number | 1649451253
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE AND WELLNESS, PC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 7110 HERITAGE VILLAGE PLAZA SUITE 101
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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 | 703-753-2922
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Fax | 703-753-4383
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Provider Business Mailing Address
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Address Line | 7110 HERITAGE VILLAGE PLAZA SUITE 101
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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 | 703-753-2922
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Fax | 703-753-4383
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER LILLIS
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Credential | M.D.
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Telephone | 703-953-8593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101237920
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License Number State | VA
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