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General NPI Number Information
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NPI Number | 1710060330
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Entity Type | Organization
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Legal Business Name | FAIRFAX FAMILY PRACTICE CENTERS, P.C.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 6201 CENTREVILLE RD STE 100
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City | CENTREVILLE
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State | VA
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Zip | 20121-2626
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Country | US
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Telephone | 703-263-9600
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Fax | 703-266-1452
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Provider Business Mailing Address
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Address Line | PO BOX 791128
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City | BALTIMORE
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State | MD
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Zip | 21279-1128
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Country | US
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Telephone | 703-391-2030
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Fax | 703-273-3943
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES P. JENKINS JR.
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Credential | MD
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Telephone | 703-391-2030
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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 | 0631926
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License Number State | VA
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Taxonomy #2
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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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