Healthcare Provider Details

I. General information

NPI: 1417474305
Provider Name (Legal Business Name): VALERIE LEW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MLK JR DR SW
ATLANTA GA
30311-1636
US

IV. Provider business mailing address

1754 E CLIFTON RD NE
ATLANTA GA
30307-1252
US

V. Phone/Fax

Practice location:
  • Phone: 404-564-7749
  • Fax:
Mailing address:
  • Phone: 925-381-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN252053
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: