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General NPI Number Information
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NPI Number | 1982154241
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 1122 PROVIDENCE WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3316
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Country | US
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Telephone | 678-442-8619
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 PROVIDENCE WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3316
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Country | US
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Telephone | 678-442-8619
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MISS CYNTHIA REGINA COLLINS
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Credential | MSW
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Telephone | 678-442-8619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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