Organization
NMG AFFILIATE PRACTICE I, LLC
Active
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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