Healthcare Provider Details

I. General information

NPI: 1508703984
Provider Name (Legal Business Name): VICTORY MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 MALL OF GEORGIA BLVD STE 304
BUFORD GA
30519-8783
US

IV. Provider business mailing address

2675 MALL OF GEORGIA BLVD STE 304
BUFORD GA
30519-8783
US

V. Phone/Fax

Practice location:
  • Phone: 404-453-6010
  • Fax: 470-742-7404
Mailing address:
  • Phone: 404-453-6010
  • Fax: 470-742-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: TABITHA LOPEZ
Title or Position: CEO
Credential:
Phone: 404-453-6010