Provider Demographics
NPI:1568588812
Name:VALENTINOVA, NATALIYA (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:VALENTINOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SKY MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-2117
Mailing Address - Country:US
Mailing Address - Phone:718-666-5207
Mailing Address - Fax:
Practice Address - Street 1:285 RIDGEWALK PKWY STE 108
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4964
Practice Address - Country:US
Practice Address - Phone:470-276-9505
Practice Address - Fax:470-276-9519
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011124363A00000X, 363AM0700X
GA10837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011124OtherLICENSE #
NY011124OtherLICENSE #