MEDICARE: MISS VALERIE NICOLE IVANOVICH

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	2084P0800X	Psychiatry Physician	110989	GA

General Provider Information

NPI Number	:	1922684018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VALERIE NICOLE IVANOVICH

Provider Business Mailing Address
First Line	:	997 SAINT SEBASTIAN WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30912-2613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	997 SAINT SEBASTIAN WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30912-2613
Country	:	US
Telephone Number	:	706-721-6597
Fax Number	:

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

Provider Enumeration Date	:	03/20/2021
Last Update Date	:	02/17/2026

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