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Organization
PRIVIA MEDICAL GROUP, LLC
Active
Organization
PRIVIA MEDICAL GROUP, LLC
Active
Other names
Falls Church Foot and Ankle Center
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR, CREDENTIALING)
(571) 366-8831
Entity
Organization
Contact information
Practice address
104A E BROAD ST STE A, FALLS CHURCH, VA 22046-4501
(703) 237-1555
Mailing address
950 N GLEBE RD STE 700, ARLINGTON, VA 22203-4173
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
261QP1100X
Podiatric Clinic/Center
—
—
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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