Provider Demographics
NPI:1265711519
Name:POWELL, VALERIA DIXON (LPN)
Entity type:Individual
Prefix:MRS
First Name:VALERIA
Middle Name:DIXON
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 AUTUMN CHASE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9207
Mailing Address - Country:US
Mailing Address - Phone:770-731-9330
Mailing Address - Fax:
Practice Address - Street 1:2157 AUTUMN CHASE DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9207
Practice Address - Country:US
Practice Address - Phone:770-731-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN057636164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse