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General NPI Number Information
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NPI Number | 1720760259
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA FAMILY CARE LLC
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 4101 CHESHIRE STATION PLAZA SUITE 500
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City | DALE CITY
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State | VA
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Zip | 22193
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Country | US
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Telephone | 571-374-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 CHESHIRE STATION PLAZA SUITE 500
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City | DALE CITY
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State | VA
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Zip | 22193
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Country | US
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Telephone | 571-374-1234
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN GILLIAM
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Credential |
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Telephone | 571-374-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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