Provider Demographics
NPI:1023474582
Name:KEATING, VIRGINIA SOURIS (NP-C)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:SOURIS
Last Name:KEATING
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 WHITEWATER CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3946
Mailing Address - Country:US
Mailing Address - Phone:404-233-5252
Mailing Address - Fax:404-233-0490
Practice Address - Street 1:3715 NORTHSIDE PKWY NW
Practice Address - Street 2:400 NORTHCREEK, STE. 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2882
Practice Address - Country:US
Practice Address - Phone:404-233-5252
Practice Address - Fax:404-233-0490
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181526363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN181526OtherPROFESSIONAL LICENSE NP-C