Provider Demographics
NPI:1609806504
Name:VA MEDICAL CENTER
Entity Type:Organization
Organization Name:VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:CAMPBELL-HEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-321-6111
Mailing Address - Street 1:940 CAPELLA CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1578
Mailing Address - Country:US
Mailing Address - Phone:770-972-3658
Mailing Address - Fax:
Practice Address - Street 1:940 CAPELLA CREEK WAY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1578
Practice Address - Country:US
Practice Address - Phone:770-972-3658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital