1033303482 NPI number — DEPARTMENT OF VETERANS AFFAIRS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033303482 NPI number — DEPARTMENT OF VETERANS AFFAIRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTMENT OF VETERANS AFFAIRS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VA MEDICAL CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033303482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4055 BROWNE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONLEY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30288-6811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-629-1761
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2675 N MARTIN ST
Provider Second Line Business Practice Location Address:
BLDG 700
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-6948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-321-6111
Provider Business Practice Location Address Fax Number:
404-327-4028
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER-REID
Authorized Official First Name:
JENIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL COORDINATOR
Authorized Official Telephone Number:
404-321-6111

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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