Healthcare Provider Details

I. General information

NPI: 1841013901
Provider Name (Legal Business Name): ANA MARIA VLASIC RN CLINICAL CASE MGR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FT EISENHOWER GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL RD
FT EISENHOWER GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-8672
  • Fax: 706-787-0105
Mailing address:
  • Phone: 706-787-8672
  • Fax: 706-787-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number648387-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number648387-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number648387-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: