Provider Demographics
NPI:1275076879
Name:VALERE MEDICAL
Entity Type:Organization
Organization Name:VALERE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:SVED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-889-2220
Mailing Address - Street 1:3331 HAMILTON MILL RD
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4096
Mailing Address - Country:US
Mailing Address - Phone:678-889-2220
Mailing Address - Fax:678-889-2722
Practice Address - Street 1:3331 HAMILTON MILL RD
Practice Address - Street 2:SUITE 1102
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4096
Practice Address - Country:US
Practice Address - Phone:678-889-2220
Practice Address - Fax:678-889-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38981261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care