Provider Demographics
NPI:1922878586
Name:PENTECOST, VERONICA ANGELA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANGELA
Last Name:PENTECOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 KYNDAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-4864
Mailing Address - Country:US
Mailing Address - Phone:404-916-9244
Mailing Address - Fax:
Practice Address - Street 1:234 KYNDAL DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-4864
Practice Address - Country:US
Practice Address - Phone:404-916-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA189765363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health