# UVA COMMUNITY HEALTH MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1962172817
- **Authorized official:** CHARLES D CODER (CFO)
- **Authorized official phone:** (804) 835-2069

## Contact information

- **Practice address:** 10322 BRISTOW CENTER DR, BRISTOW, VA 20136-2201
- **Practice address phone:** (571) 284-4230
- **Practice address fax:** (703) 257-1495
- **Mailing address:** PO BOX 748613, ATLANTA, GA 30384-8613

## Taxonomy

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

## Other

- **Enumeration date:** 09/14/2021
- **Last updated:** 09/26/2023