Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Other names
UVA Breast Surgery Woodbridge
Organization subpart
No
Provider details
NPI number
Authorized official
SHALA DAVIS (RCS MANAGER)
(704) 303-7517
Entity
Organization
Contact information
Practice address
14010 SMOKETOWN RD STE 105, WOODBRIDGE, VA 22192-4723
(703) 730-4848
(703) 730-7236
Mailing address
PO BOX 936952, ATLANTA, GA 31193-6952
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831466440
—
VA
Enumeration date
11/28/2011
Last updated
09/14/2021
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