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General NPI Number Information
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NPI Number | 1528867033
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Entity Type | Individual
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Provider Name | VEDA LATRICE GOINS OWNER
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 4827 OLD NATIONAL HWY STE 1055
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City | COLLEGE PARK
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State | GA
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Zip | 30337-6234
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Country | US
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Telephone | 770-771-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 FLAT SHOALS RD APT 1208
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City | UNION CITY
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State | GA
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Zip | 30291-2401
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Country | US
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Telephone | 770-771-3588
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Fax |
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | CKA8721
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License Number State | GA
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