1841515780 NPI number — DENISE C. DE VERANEZ, M.D., P.C.

Table of content: RAQUEL ANGELINA DULANEY LMT (NPI 1639483050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841515780 NPI number — DENISE C. DE VERANEZ, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENISE C. DE VERANEZ, M.D., P.C.
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:
Provider Other Organization Name Type Code:
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:
1841515780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 LANG DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214-3894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-507-1414
Provider Business Mailing Address Fax Number:
770-507-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 COUNTRY CLUB DR
Provider Second Line Business Practice Location Address:
BLDG. 100, STE. C
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-9054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-507-1414
Provider Business Practice Location Address Fax Number:
770-507-5150
Provider Enumeration Date:
04/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DE VERANEZ
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
CHERYL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-507-1414

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  041279 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com