Healthcare Provider Details

I. General information

NPI: 1841350063
Provider Name (Legal Business Name): THE VERANDA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 MEREDYTH DR
ALBANY GA
31707-2267
US

IV. Provider business mailing address

2701 MEREDYTH DR
ALBANY GA
31707-2267
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-7010
  • Fax: 229-435-4022
Mailing address:
  • Phone: 229-883-7010
  • Fax: 229-435-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number062238
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE BUTLER
Title or Position: BILLING OFFICE MANAGER
Credential:
Phone: 229-883-7010