Organization
FORT CHISWELL FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH WASHINGTON (VP)
(703) 650-2907
Entity
Organization
Contact information
Practice address
245 FORT CHISWELL RD, FORT CHISWELL PLAZA SUITE D, MAX MEADOWS, VA 24360-3986
(276) 637-4300
(276) 637-4301
Mailing address
245 FORT CHISWELL RD, FORT CHISWELL PLAZA SUITE D, MAX MEADOWS, VA 24360-3986
(276) 637-4300
(276) 637-4301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962443721
—
VA
Enumeration date
06/10/2006
Last updated
01/21/2008
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