Provider Demographics
NPI:1851406359
Name:ANDREWS, VALISIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:VALISIA
Middle Name:A
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:BUILDING E, SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5909
Mailing Address - Country:US
Mailing Address - Phone:404-250-3660
Mailing Address - Fax:404-250-3665
Practice Address - Street 1:6105 PEACHTREE DUNWOODY RD
Practice Address - Street 2:BUILDING E, SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5909
Practice Address - Country:US
Practice Address - Phone:404-250-3660
Practice Address - Fax:404-250-3665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000819959BMedicaid
GA16BBDGPMedicare ID - Type Unspecified
GA000819959BMedicaid