Provider Demographics
NPI:1336224187
Name:JEAN Y REDDING
Entity Type:Organization
Organization Name:JEAN Y REDDING
Other - Org Name:SHERWOOD HALL FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:SOLE PROPRIETORSHIP
Authorized Official - Phone:703-360-6200
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:SUITE 407
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-360-6200
Mailing Address - Fax:703-360-6091
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 407
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-360-6200
Practice Address - Fax:703-360-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0507097261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care