Healthcare Provider Details

I. General information

NPI: 1689885501
Provider Name (Legal Business Name): VIRGIL FIGUEROA CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 HOSPITAL RD
CANTON GA
30114-2432
US

IV. Provider business mailing address

320 HOSPITAL RD
CANTON GA
30114-2432
US

V. Phone/Fax

Practice location:
  • Phone: 770-479-5535
  • Fax: 770-720-3294
Mailing address:
  • Phone: 770-479-5535
  • Fax: 770-479-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN144625
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN144625
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: