MEDICARE: VERNU MED SPA

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1992272330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNU MED SPA

Provider Business Mailing Address
First Line	:	11770 HAYNES BRIDGE RD STE 205-499
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-1966
Country	:	US
Telephone Number	:	770-559-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S MAIN ST STE 202
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-1975
Country	:	US
Telephone Number	:	770-559-0055
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CINDY MCLENDON HINTON
Credential	:	MSN, FNP-C
Telephone Number	:	770-559-0055

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	12/11/2018

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