Provider Demographics
NPI:1265477863
Name:ATLANTA VA MEDICAL CENTER
Entity Type:Organization
Organization Name:ATLANTA VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:YLBA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-321-6111
Mailing Address - Street 1:6 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2810
Mailing Address - Country:US
Mailing Address - Phone:678-833-5759
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR018134313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility