Provider Demographics
NPI:1023460938
Name:LABELLA, VIRGINIA PERSONS
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:PERSONS
Last Name:LABELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VIRGINIA
Other - Middle Name:CALHOUN
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:340 EXCHANGE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-1759
Mailing Address - Country:US
Mailing Address - Phone:678-963-7171
Mailing Address - Fax:
Practice Address - Street 1:340 EXCHANGE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620
Practice Address - Country:US
Practice Address - Phone:678-963-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily