Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Other names
UVA Diabetes and Nutrition Manassas
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
8644 SUDLEY RD STE 315, MANASSAS, VA 20110-4425
(703) 369-8405
(703) 369-8533
Mailing address
PO BOX 936952, ATLANTA, GA 31193-6952
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/30/2020
Last updated
09/14/2021
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