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General NPI Number Information
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NPI Number | 1801887732
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Entity Type | Individual
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Provider Name | PARNELL CHARLES MATTISON D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 9501 FARRELL ROAD PEDIATRIC SERVICE
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City | FORT BELVOIR
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State | VA
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Zip | 22060
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Country | US
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Telephone | 703-805-0531
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Fax | 703-805-9024
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Provider Business Mailing Address
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Address Line | 7807 BLUE JASMINE CT
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City | SPRINGFIELD
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State | VA
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Zip | 22153-2128
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Country | US
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Telephone | 703-455-3355
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 050860
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License Number State | GA
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