# NMG AFFILIATE PRACTICE I, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health UVA Health System Lake Manassas OBGYN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669825105
- **Authorized official:** GEOFFREY K. GARDNER (VP OF FINANCE)
- **Authorized official phone:** (704) 384-7680

## Contact information

- **Practice address:** 15195 HEATHCOTE BLVD, SUITE 338, HAYMARKET, VA 20169-6242
- **Practice address phone:** (571) 261-3270
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (704) 384-7680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2016
- **Last updated:** 07/20/2016