Provider Demographics
NPI:1851558811
Name:VALLEY VIEW MEDICAL CENTER
Entity Type:Organization
Organization Name:VALLEY VIEW MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER CHARGE NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:706-867-6505
Mailing Address - Street 1:24 ALICIA LN
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1612
Mailing Address - Country:US
Mailing Address - Phone:706-867-6505
Mailing Address - Fax:706-867-9994
Practice Address - Street 1:24 ALICIA LN
Practice Address - Street 2:SUITE 7
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1612
Practice Address - Country:US
Practice Address - Phone:706-867-6505
Practice Address - Fax:706-867-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037640261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00569753JMedicaid
GAF68885Medicare UPIN