Individual
JACOB A IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
7521 JAGUAR TRL, FALLS CHURCH, VA 22042-7511
(703) 207-4041
(703) 207-4012
Mailing address
7521 JAGUAR TRL, FALLS CHURCH, VA 22042-7511
(703) 207-4041
(703) 207-4012
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0126001899
VA
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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