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8644 Sudley Rd Ste 315 Manassas VA 20110-4425 | |
| (703) 369-8405 | |
| (703) 369-8533 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 8644 Sudley Rd Ste 315, Manassas, Virginia |
| Authorized Official Name and Position | Shala Davis (RCS MANAGER) |
| Authorized Official Contact | 7043037517 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 936952 Atlanta GA 31193-6952 Ph: () - | 8644 Sudley Rd Ste 315 Manassas VA 20110-4425 Ph: (703) 369-8405 |
| NPI Number | 1063016160 |
|---|---|
| Provider Enumeration Date | 11/30/2020 |
| Last Update Date | 09/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063016160 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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