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NPI Code Detail

MEDICARE: VERNU 2

MEDICARE: VERNU 2
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285242024
Entity Type Code : Organization
Provider Name (Legal Business Name) : VERNU 2
Provider Business Mailing Address
First Line : 11680 GREAT OAKS WAY STE 170
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-2483
Country : US
Telephone Number : 678-855-6535
Fax Number : 770-203-1072
Provider Business Practice Location Address
First Line : 11680 GREAT OAKS WAY STE 170
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-2483
Country : US
Telephone Number : 678-855-6535
Fax Number : 770-203-1072
Authorized Official
Title or Position : OWNER
Name : KELLY MCCANTS
Credential : MD
Telephone Number : 270-945-3095
Provider Enumeration Date : 07/17/2020
Last Update Date : 05/20/2025

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Directions to “VERNU 2 ” Practice Location

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