# NMG AFFILIATE PRACTICE I, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health UVA Health System Bristow Run Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295169605
- **Authorized official:** GEOFFREY GARDNER (VP OF FINANCE)
- **Authorized official phone:** (703) 753-9799

## Contact information

- **Practice address:** 14540 JOHN MARSHALL HWY, SUITE 104, GAINESVILLE, VA 20155-1691
- **Practice address phone:** (703) 753-9799
- **Practice address fax:** (703) 753-9792
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (703) 753-9799

## Taxonomy

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

## Other

- **Enumeration date:** 08/22/2013
- **Last updated:** 04/06/2016