Provider Demographics
NPI:1376645689
Name:VERANET HEALTHCARE, LLC
Entity Type:Organization
Organization Name:VERANET HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-853-4067
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180
Mailing Address - Country:US
Mailing Address - Phone:770-771-5235
Mailing Address - Fax:770-771-5236
Practice Address - Street 1:403 PERMIAN WAY
Practice Address - Street 2:SUITE A
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3203
Practice Address - Country:US
Practice Address - Phone:770-771-5235
Practice Address - Fax:770-771-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7837Medicare PIN
GAE44987Medicare UPIN