MEDICARE: VEDA LATRICE GOINS OWNER

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
1	347C00000X	Private Vehicle	CKA8721	GA

General Provider Information

NPI Number	:	1528867033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VEDA LATRICE GOINS OWNER

Provider Business Mailing Address
First Line	:	4300 FLAT SHOALS RD APT 1208
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-2401
Country	:	US
Telephone Number	:	770-771-3588
Fax Number	:

Provider Business Practice Location Address
First Line	:	4827 OLD NATIONAL HWY STE 1055
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-6234
Country	:	US
Telephone Number	:	770-771-3588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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