Healthcare Provider Details

I. General information

NPI: 1316195787
Provider Name (Legal Business Name): MRS. VALERIE KAY STAPLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PEACHTREE INDUSTRIAL BLVD STE 260
SUWANEE GA
30024-8493
US

IV. Provider business mailing address

1500 PEACHTREE INDUSTRIAL BLVD STE 260
SUWANEE GA
30024-8493
US

V. Phone/Fax

Practice location:
  • Phone: 770-614-8914
  • Fax: 770-614-8917
Mailing address:
  • Phone: 770-614-8914
  • Fax: 770-614-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: