Provider Demographics
NPI:1316191075
Name:VERALYNN HEALTH MANAGEMENT, LLC
Entity Type:Organization
Organization Name:VERALYNN HEALTH MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:706-845-1473
Mailing Address - Street 1:273 STOVALL RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-9094
Mailing Address - Country:US
Mailing Address - Phone:706-845-1473
Mailing Address - Fax:336-553-3994
Practice Address - Street 1:521 FRANKLIN SPRINGS ST
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3934
Practice Address - Country:US
Practice Address - Phone:706-245-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN065069367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty