Organization
POTOMAC HEALTHCARE SOLUTIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAPHNEY JACKSON (CREDENTIALING MANAGER)
(703) 498-2773
Entity
Organization
Contact information
Practice address
1549 OLD BRIDGE RD STE 201, WOODBRIDGE, VA 22192-2737
(703) 498-2773
(703) 542-1772
Mailing address
1549 OLD BRIDGE RD STE 201, WOODBRIDGE, VA 22192-2737
(703) 498-2773
(703) 542-1772
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
S4081867
VA
291U00000X
Clinical Medical Laboratory
S4081867
VA
Other
Enumeration date
06/12/2015
Last updated
06/12/2015
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