Healthcare Provider Details

I. General information

NPI: 1881999852
Provider Name (Legal Business Name): JAVIER VALLE M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N SHALLOWFORD RD
ATLANTA GA
30338-6476
US

IV. Provider business mailing address

4500 N SHALLOWFORD RD
ATLANTA GA
30338-6476
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6920
  • Fax:
Mailing address:
  • Phone: 404-778-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number74127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: