Provider Demographics
NPI:1427457886
Name:ADDISON, VERONICA
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:ADDISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CORPORATE CENTER DR STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7214
Mailing Address - Country:US
Mailing Address - Phone:404-565-5544
Mailing Address - Fax:
Practice Address - Street 1:219 INDIANAPOLIS BLVD
Practice Address - Street 2:STE B
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322
Practice Address - Country:US
Practice Address - Phone:219-237-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health