Healthcare Provider Details

I. General information

NPI: 1164507661
Provider Name (Legal Business Name): MS. JULIA MARIE VEASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 LEGION DRIVE
WARRENTON GA
30828
US

IV. Provider business mailing address

747 HOLT ST
THOMSON GA
30824-1759
US

V. Phone/Fax

Practice location:
  • Phone: 706-465-2252
  • Fax: 706-465-1410
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN083134
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: