Provider Demographics
NPI:1508422148
Name:PAUL, ALVETA CHARLENE
Entity Type:Individual
Prefix:
First Name:ALVETA
Middle Name:CHARLENE
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-7859
Mailing Address - Country:US
Mailing Address - Phone:505-226-4330
Mailing Address - Fax:229-329-4256
Practice Address - Street 1:427 S 3RD ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-7859
Practice Address - Country:US
Practice Address - Phone:505-226-4330
Practice Address - Fax:229-329-4256
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide