Healthcare Provider Details

I. General information

NPI: 1306915590
Provider Name (Legal Business Name): DALE RICHARD VALENTINE R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 DANBY CT
DORAVILLE GA
30340-4921
US

IV. Provider business mailing address

2818 DANBY CT
DORAVILLE GA
30340-4921
US

V. Phone/Fax

Practice location:
  • Phone: 770-248-8757
  • Fax:
Mailing address:
  • Phone: 770-248-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN075239
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: