Organization
FAMILY MEDICAL CENTER HOLDING LLC
Active
Organization
FAMILY MEDICAL CENTER HOLDING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLU JABATI (MD/MEDICAL DIRECTOR)
(703) 497-4500
Entity
Organization
Contact information
Practice address
14904 JEFFERSON DAVIS HWY STE 205, WOODBRIDGE, VA 22191-3908
(703) 497-4500
(703) 494-4671
Mailing address
14904 JEFFERSON DAVIS HWY STE 205, WOODBRIDGE, VA 22191-3908
(703) 497-4500
(703) 494-4671
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101240114
VA
207R00000X
Internal Medicine Physician
0101240114
VA
208VP0014X
Interventional Pain Medicine Physician
Primary
0101240114
VA
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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