Healthcare Provider Details

I. General information

NPI: 1376645689
Provider Name (Legal Business Name): VERANET HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 PERMIAN WAY SUITE A
VILLA RICA GA
30180-3203
US

IV. Provider business mailing address

PO BOX 1615
VILLA RICA GA
30180
US

V. Phone/Fax

Practice location:
  • Phone: 770-771-5235
  • Fax: 770-771-5236
Mailing address:
  • Phone: 770-771-5235
  • Fax: 770-771-5236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052389
License Number StateGA

VIII. Authorized Official

Name: DR. MERNA MICHELLE VERA
Title or Position: PRESIDENT
Credential: MD
Phone: 770-853-4067