# NMG AFFILIATE PRACTICE I, LLC

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

## Provider details

- **NPI number:** 1922449263
- **Authorized official:** GEOFFREY K GARDNER (VP OF FINANCE)
- **Authorized official phone:** (571) 261-3529

## Contact information

- **Practice address:** 25055 RIDING PLZ, SUITE 230, SOUTH RIDING, VA 20152-5917
- **Practice address phone:** (703) 361-3551
- **Practice address fax:** (703) 365-7702
- **Mailing address:** PO BOX 60447, CHARLOTTE, NC 28260-0447
- **Mailing address phone:** (703) 361-3551
- **Mailing address fax:** (703) 365-7702

## Taxonomy

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

## Other

- **Enumeration date:** 07/16/2013
- **Last updated:** 04/06/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1922449263 | — | VA |