Healthcare Provider Details

I. General information

NPI: 1275191876
Provider Name (Legal Business Name): VALERIE VINTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 CANTON RD STE 130
MARIETTA GA
30066-2660
US

IV. Provider business mailing address

3660 CANTON RD STE 130
MARIETTA GA
30066-2660
US

V. Phone/Fax

Practice location:
  • Phone: 678-448-6570
  • Fax: 470-523-2580
Mailing address:
  • Phone: 678-448-6570
  • Fax: 470-523-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN249227
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP249227
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: