Healthcare Provider Details

I. General information

NPI: 1740650928
Provider Name (Legal Business Name): VICTORIA MURIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 OCONEE FARMS RD
GREENSBORO GA
30642-2059
US

IV. Provider business mailing address

1201 OCTOBER FARMS RD
GREENSBORO GA
30642
US

V. Phone/Fax

Practice location:
  • Phone: 770-243-5753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1160954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: