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General NPI Number Information
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NPI Number | 1598278558
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Entity Type | Individual
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Provider Name | VERA MAHOU NP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 1115 MOUNT ZION RD STE J
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City | MORROW
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State | GA
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Zip | 30260-2266
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Country | US
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Telephone | 404-422-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 REDDY FARM RD
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City | GRAYSON
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State | GA
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Zip | 30017-1754
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Country | US
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Telephone | 404-883-9140
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Fax | 531-200-7387
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN220109
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN220109
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License Number State | GA
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