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General NPI Number Information
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NPI Number | 1003268756
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Entity Type | Individual
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Provider Name | VALENCIA TUTEIN
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Gender | Female
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 1600 SUGARMAPLE LN SW
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City | CONYERS
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State | GA
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Zip | 30094-6282
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Country | US
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Telephone | 770-985-4257
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Fax | 770-985-4258
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Provider Business Mailing Address
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Address Line | 1600 SUGARMAPLE LN SW
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City | CONYERS
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State | GA
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Zip | 30094-6282
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Country | US
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Telephone | 770-985-4257
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Fax | 770-985-4258
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 272947085
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License Number State | GA
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