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General NPI Number Information
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NPI Number | 1124054317
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Entity Type | Organization
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Legal Business Name | VETERANS AFFAIRS MEDICAL CENTER
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2731 HIGHWAY 212 SW
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City | CONYERS
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State | GA
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Zip | 30094-3352
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Country | US
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Telephone | 678-413-3812
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Fax | 678-413-3812
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Provider Business Mailing Address
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Address Line | 2731 HIGHWAY 212 SW
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City | CONYERS
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State | GA
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Zip | 30094-3352
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Country | US
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Telephone | 678-413-3812
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Fax | 678-413-3812
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Authorized Official
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Title or Position | CHARGE NURSE
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Name | MRS. QUEEN BISHOP CATCHINGS
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Credential | REGISTERED NURSE
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Telephone | 404-321-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | RN053192
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License Number State | GA
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