Individual
KAHLIL ASHLEY GAITERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10945 GEORGE MASON CIR STE 105, MANASSAS, VA 20110-2233
(703) 361-5116
(571) 364-8911
Mailing address
PO BOX 936952, ATLANTA, GA 31193-6952
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102207285
VA
390200000X
Student in an Organized Health Care Education/Training Program
0116033462
VA
Other
Enumeration date
07/19/2019
Last updated
01/27/2023
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