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General NPI Number Information
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NPI Number | 1174309488
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Entity Type | Organization
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Legal Business Name | VALIANT THERAPY LLC
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 4255 CEDAR BLUFF WAY SW
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City | LILBURN
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State | GA
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Zip | 30047-3185
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Country | US
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Telephone | 470-981-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 4255 CEDAR BLUFF WAY SW
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City | LILBURN
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State | GA
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Zip | 30047-3185
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Country | US
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Telephone | 470-981-6333
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALISTS
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Name | KIMBERLY DAVIS
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Credential |
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Telephone | 912-373-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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