Individual
MR. MICAIAH LANDRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1101 SAM PERRY BLVD STE 400, FREDERICKSBURG, VA 22401-4466
(540) 741-2871
Mailing address
1101 SAM PERRY BLVD STE 400, FREDERICKSBURG, VA 22401-4466
(540) 741-2871
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110010722
VA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
10/03/2024
Last updated
05/16/2025
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