Healthcare Provider Details

I. General information

NPI: 1760670731
Provider Name (Legal Business Name): CARL VINSON VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 VETERANS BLVD
DUBLIN GA
31021-3620
US

IV. Provider business mailing address

1826 VETERANS BLVD
DUBLIN GA
31021-3620
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1210
  • Fax:
Mailing address:
  • Phone: 478-272-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberRN082069NP
License Number StateGA

VIII. Authorized Official

Name: MS. JAN HASKINS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 478-277-2804