Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Other names
Novant Health UVA Health System Northern Virginia Psychiatric Associa
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY K. GARDNER (VP OF FINANCE)
(703) 369-8464
Entity
Organization
Contact information
Practice address
8680 HOSPITAL WAY, MANASSAS, VA 20110-4287
(703) 369-8464
(703) 369-8467
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(703) 369-8464
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
08/14/2014
Last updated
09/28/2016
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