Healthcare Provider Details

I. General information

NPI: 1376233502
Provider Name (Legal Business Name): VALARIE BELLAH FASUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALARIE FASUE CPT, MA

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 08/09/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 HIGHWAY 42 N
MCDONOUGH GA
30253-4725
US

IV. Provider business mailing address

1783 HIGHWAY 42 N
MCDONOUGH GA
30253-4725
US

V. Phone/Fax

Practice location:
  • Phone: 678-759-0420
  • Fax:
Mailing address:
  • Phone: 678-759-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number11D2292287
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: