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General NPI Number Information
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NPI Number | 1265477863
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Entity Type | Organization
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Legal Business Name | ATLANTA VA MEDICAL CENTER
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 6 FAIRFIELD DR
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City | ELLENWOOD
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State | GA
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Zip | 30294-2810
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Country | US
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Telephone | 678-833-5759
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MS. YLBA M HOOKER
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Credential | RN
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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 | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 018134
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License Number State | PR
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