Healthcare Provider Details

I. General information

NPI: 1972321719
Provider Name (Legal Business Name): VALEISHA FAGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 FOX LN
RICHLAND GA
31825-5002
US

IV. Provider business mailing address

125 RIDGEWOOD DR
AMERICUS GA
31709-5844
US

V. Phone/Fax

Practice location:
  • Phone: 229-942-7430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: