# PRIVIA MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Falls Church Foot and Ankle Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558919134
- **Authorized official:** COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR, CREDENTIALING)
- **Authorized official phone:** (571) 366-8831

## Contact information

- **Practice address:** 104A E BROAD ST STE A, FALLS CHURCH, VA 22046-4501
- **Practice address phone:** (703) 237-1555
- **Mailing address:** 950 N GLEBE RD STE 700, ARLINGTON, VA 22203-4173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |
| 261QP1100X | Podiatric Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/28/2019
- **Last updated:** 08/28/2019