Provider Demographics
NPI:1417420621
Name:ZION FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:ZION FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-412-7454
Mailing Address - Street 1:CAPITOL HILL, 611 PENNSYLVANIA AVENUE, SE
Mailing Address - Street 2:#241
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003
Mailing Address - Country:US
Mailing Address - Phone:301-500-0779
Mailing Address - Fax:
Practice Address - Street 1:2616 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7715
Practice Address - Country:US
Practice Address - Phone:301-500-0779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty