| Uncharted Territory, LLC | |
|
2761 Jefferson Davis Hwy Ste 101 Stafford VA 22554-8330 | |
| (540) 216-0093 | |
| (540) 446-5462 |
| Full Name | Uncharted Territory, LLC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2761 Jefferson Davis Hwy Ste 101, Stafford, Virginia |
| Authorized Official Name and Position | Joni J Johnson (OWNER) |
| Authorized Official Contact | 5408456577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Uncharted Territory, LLC 328 Boxelder Dr Stafford VA 22554-6844 Ph: (540) 845-6577 | Uncharted Territory, LLC 2761 Jefferson Davis Hwy Ste 101 Stafford VA 22554-8330 Ph: (540) 216-0093 |
| NPI Number | 1629688759 |
|---|---|
| Provider Enumeration Date | 08/04/2020 |
| Last Update Date | 08/04/2020 |
| Certification Date | 08/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629688759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
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