Healthcare Provider Details

I. General information

NPI: 1225222524
Provider Name (Legal Business Name): DENISE S VAZ C-PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CANTON RD
CUMMING GA
30040-2304
US

IV. Provider business mailing address

204 CANTON RD
CUMMING GA
30040-2304
US

V. Phone/Fax

Practice location:
  • Phone: 770-886-5437
  • Fax: 770-886-9717
Mailing address:
  • Phone: 770-886-5437
  • Fax: 770-886-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN172992NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: