Provider Demographics
NPI:1194330787
Name:VERA, QUANISHA ALIYAH (CEO)
Entity type:Individual
Prefix:
First Name:QUANISHA
Middle Name:ALIYAH
Last Name:VERA
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9373
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-9373
Mailing Address - Country:US
Mailing Address - Phone:706-910-3580
Mailing Address - Fax:
Practice Address - Street 1:119 DAVIS RD STE 5C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0217
Practice Address - Country:US
Practice Address - Phone:706-910-3580
Practice Address - Fax:706-925-5723
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker