| NPI | 1578021317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE NEVADA JOHNSON Credentialing COO Rdinator 540-536-0103 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2021-04-14 |