Healthcare Provider Details

I. General information

NPI: 1124054317
Provider Name (Legal Business Name): VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 HIGHWAY 212 SW
CONYERS GA
30094-3352
US

IV. Provider business mailing address

2731 HIGHWAY 212 SW
CONYERS GA
30094-3352
US

V. Phone/Fax

Practice location:
  • Phone: 678-413-3812
  • Fax: 678-413-3812
Mailing address:
  • Phone: 678-413-3812
  • Fax: 678-413-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberRN053192
License Number StateGA

VIII. Authorized Official

Name: MRS. QUEEN BISHOP CATCHINGS
Title or Position: CHARGE NURSE
Credential: REGISTERED NURSE
Phone: 404-321-6111