Healthcare Provider Details

I. General information

NPI: 1770528309
Provider Name (Legal Business Name): DEPT. OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 STONE MILL TRCE
STONE MTN GA
30083-1526
US

IV. Provider business mailing address

1449 STONE MILL TRCE
STONE MTN GA
30083-1526
US

V. Phone/Fax

Practice location:
  • Phone: 404-434-3642
  • Fax:
Mailing address:
  • Phone: 404-434-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number2-024570
License Number StateAL

VIII. Authorized Official

Name: MS. GLORIA A. MILLIGAN
Title or Position: LPN
Credential: NURSING
Phone: 404-728-7614