MEDICARE: VALERIE MARIE FAULK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	128033	GA

General Provider Information

NPI Number	:	1902421787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE MARIE FAULK CRNA

Provider Business Mailing Address
First Line	:	531 ROSELANE ST NW STE 830
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-6979
Country	:	US
Telephone Number	:	770-794-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 ROSELANE ST NW STE 830
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-6979
Country	:	US
Telephone Number	:	770-794-0477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	03/27/2026

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