Provider Demographics
NPI:1184328874
Name:GENMEDX
Entity type:Organization
Organization Name:GENMEDX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DCN, CNS, MS, LDN
Authorized Official - Phone:804-337-9820
Mailing Address - Street 1:16521 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-1638
Mailing Address - Country:US
Mailing Address - Phone:804-337-9820
Mailing Address - Fax:
Practice Address - Street 1:16521 RIVER RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-1638
Practice Address - Country:US
Practice Address - Phone:804-337-9820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205016102OtherNPPES
1770923179OtherNPPES
1104052562OtherNPPES
1043852544OtherNPPES
1275032385OtherNPPES