Provider Demographics
NPI:1184314007
Name:PYNN, VALERIE NADINE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:NADINE
Last Name:PYNN
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 1:150 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2400
Mailing Address - Country:US
Mailing Address - Phone:706-614-2622
Mailing Address - Fax:
Practice Address - Street 1:150 TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2400
Practice Address - Country:US
Practice Address - Phone:706-614-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA220405171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator