# PRIVIA MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154961316
- **Authorized official:** COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR, CREDENTIALING)
- **Authorized official phone:** (571) 366-8831

## Contact information

- **Practice address:** 24560 SOUTHPOINT DR STE 200, ALDIE, VA 20105-3505
- **Practice address phone:** (315) 601-0174
- **Mailing address:** 950 N GLEBE RD STE 700, ARLINGTON, VA 22203-4173
- **Mailing address phone:** (571) 366-8850

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 01/15/2020
- **Last updated:** 03/11/2020