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General NPI Number Information
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NPI Number | 1306874219
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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 | 06/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 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 | 404-329-4632
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Provider Business Mailing Address
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Address Line | 630 CREEKVIEW BLVD
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City | COVINGTON
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State | GA
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Zip | 30016-3085
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Country | US
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Telephone | 770-385-7377
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Fax |
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Authorized Official
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Title or Position | CHARGE NURSE
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Name | MS. MELODYE MARGUERITE JACOBS
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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 | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | R109830
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License Number State | GA
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