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General NPI Number Information
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NPI Number | 1891854014
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Entity Type | Organization
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Legal Business Name | AHC KENNER-FT GREGG-ADAMS
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 700 24TH ST
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City | FORT LEE
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State | VA
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Zip | 23801-1716
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Country | US
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Telephone | 804-734-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 700 24TH ST ATTN PAD
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City | FORT LEE
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State | VA
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Zip | 23801-1716
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Country | US
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Telephone | 804-734-9306
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Fax |
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Authorized Official
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Title or Position | UBO MANAGER
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Name | FAYA HARR
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Credential |
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Telephone | 804-734-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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