Provider Demographics
NPI:1962194522
Name:MCCALL, VANACIA LATRELL (LPN)
Entity type:Individual
Prefix:
First Name:VANACIA
Middle Name:LATRELL
Last Name:MCCALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MLK AVE
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7804
Mailing Address - Country:US
Mailing Address - Phone:912-850-3213
Mailing Address - Fax:
Practice Address - Street 1:900 MLK AVE
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-7804
Practice Address - Country:US
Practice Address - Phone:912-850-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071986164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse