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General NPI Number Information
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NPI Number | 1881765279
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Entity Type | Organization
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Legal Business Name | HERITAGE FAMILY PRACTICE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 4001 FAIR RIDGE DR #101
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City | FAIRFAX
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State | VA
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Zip | 22033-2917
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Country | US
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Telephone | 703-385-6789
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Fax | 703-352-9409
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Provider Business Mailing Address
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Address Line | 4001 FAIR RIDGE DR #101
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City | FAIRFAX
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State | VA
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Zip | 22033-2917
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Country | US
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Telephone | 703-385-6789
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Fax | 703-352-9409
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JAMES OVERTON
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Credential |
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Telephone | 703-385-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0645748
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License Number State | VA
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