Provider Demographics
NPI:1124054317
Name:VETERANS AFFAIRS MEDICAL CENTER
Entity type:Organization
Organization Name:VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHARGE NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUEEN
Authorized Official - Middle Name:BISHOP
Authorized Official - Last Name:CATCHINGS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:404-321-6111
Mailing Address - Street 1:2731 HIGHWAY 212 SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3352
Mailing Address - Country:US
Mailing Address - Phone:678-413-3812
Mailing Address - Fax:678-413-3812
Practice Address - Street 1:2731 HIGHWAY 212 SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3352
Practice Address - Country:US
Practice Address - Phone:678-413-3812
Practice Address - Fax:678-413-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN053192372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty