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Organization
PRIVIA MEDICAL GROUP, LLC
Active
Organization
PRIVIA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR, CREDENTIALING)
(571) 366-8831
Entity
Organization
Contact information
Practice address
24560 SOUTHPOINT DR STE 200, ALDIE, VA 20105-3505
(315) 601-0174
Mailing address
950 N GLEBE RD STE 700, ARLINGTON, VA 22203-4173
(571) 366-8850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
01/15/2020
Last updated
03/11/2020
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