Provider Demographics
NPI:1760533541
Name:VEMANDAL NURSING SERVICES INC.
Entity Type:Organization
Organization Name:VEMANDAL NURSING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:AYUK
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C, FNP-BC
Authorized Official - Phone:770-577-7327
Mailing Address - Street 1:PO BOX 1563
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-1563
Mailing Address - Country:US
Mailing Address - Phone:770-577-7327
Mailing Address - Fax:770-577-6573
Practice Address - Street 1:34OO CHAPEL HILL ROAD
Practice Address - Street 2:SUITE 307
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135
Practice Address - Country:US
Practice Address - Phone:770-577-7327
Practice Address - Fax:770-577-6573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048-R-0024251J00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA040968984BMedicaid
GA040968984CMedicaid