Individual
DERRICK JOHN MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ALFA
Contact information
Practice address
9827 SUDLEY MANOR DR, MANASSAS, VA 20109-6232
(703) 530-7751
Mailing address
9827 SUDLEY MANOR DR, MANASSAS, VA 20109-6232
(703) 530-7751
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
1706000192
VA
Other
Enumeration date
01/28/2009
Last updated
01/28/2009
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