Healthcare Provider Details

I. General information

NPI: 1952157810
Provider Name (Legal Business Name): VICTORIA L MULFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

1906 WHITE PINE DR
NORTH AUGUSTA SC
29841-2147
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-2965
  • Fax:
Mailing address:
  • Phone: 404-831-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN287748
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN287748
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: