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EVERNORTH CARE PROVIDERS - TENNESSEE PC
NPI 1174304976
General Practice in Fairfax, VA

Active since October 09, 2023
11350 RANDOM HILLS RD STE 800, FAIRFAX, VA 22030(773) 292-4800(312) 564-4059 Get Directions Write a Review

NPPES record last updated: July 14, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Evernorth Care Providers - Tennessee Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERNORTH CARE PROVIDERS - TENNESSEE PC (NPI 1174304976) is a healthcare organization registered as a general practice in Fairfax, Virginia and active in the NPI registry since October 2023. The organization lists Jacqueline D Lakes, Senior Paralegal, as its authorized official.

NPPES Registry Identity

NPI1174304976
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameEVERNORTH CARE PROVIDERS - TENNESSEE PC
Location Address11350 RANDOM HILLS RD STE 800Fairfax, VA 22030-6044
Mailing Address730 Cool Springs Blvd Ste 500Franklin, TN 37067-7331 · (773) 292-4800 · Fax (312) 564-4059
Phone(773) 292-4800
Fax(312) 564-4059
Organization SubpartNo
Authorized OfficialJacqueline D LakesSenior Paralegal · (954) 446-0640
Enumeration DateOctober 9, 2023
Last NPPES UpdateJuly 14, 2025
NPPES CertifiedJuly 14, 2025
✔ NPI 1174304976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
11350 RANDOM HILLS RD STE 800, Fairfax, VA 22030
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JESSYGARCARE
Nurse's Aide
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (571) 549-0040
JORDAN RUDAT
Behavior Technician
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (301) 444-5001
KATALYST HEALTHCARE CORPORATION
Clinic/Center (Health Service)
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (202) 734-1298
MARCI DIANNE SMITH LCSW
Social Worker (Clinical)
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (571) 517-1363
CHESAPEAKE DME LLC
Durable Medical Equipment & Medical Supplies
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (888) 797-0057
KONE MOLECULAR LABS LLC
Clinical Medical Laboratory
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (888) 981-8777
LIFELINE PSYCHOTHERAPY SERVICES
Marriage & Family Therapist
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (703) 409-6258
SENIORS HOME ASSISTANCE, LLC
Home Health
11350 RANDOM HILLS RD STE 800
FAIRFAX, VA 22030
Fairfax City (855) 274-5000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evernorth Care Providers - Tennessee PC's NPI number?

The NPI number for Evernorth Care Providers - Tennessee PC is 1174304976. It was assigned to this organization in the NPPES registry on October 9, 2023.

Where is Evernorth Care Providers - Tennessee PC located?

Evernorth Care Providers - Tennessee PC is located at 11350 Random Hills Rd Ste 800, Fairfax, VA 22030. The listed phone number is (773) 292-4800.

What is Evernorth Care Providers - Tennessee PC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Evernorth Care Providers - Tennessee PC was last updated on July 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.