Provider Demographics
NPI:1598108524
Name:BUNDY, VIRGINIA MARIA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARIA
Last Name:BUNDY
Suffix:
Gender:F
Credentials:FNP-C
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Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PARKWAY BUILDING A
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-664-8898
Mailing Address - Fax:770-772-4377
Practice Address - Street 1:3400 OLD MILTON PARKWAY BUILDING A
Practice Address - Street 2:SUITE 130
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-664-8898
Practice Address - Fax:770-772-4377
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN050495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149838AMedicaid
GA003149838AMedicaid