Provider Demographics
NPI:1700993326
Name:VETERANS ADMINSTRATION
Entity Type:Organization
Organization Name:VETERANS ADMINSTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARGE NORSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HARRACKSINGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:401-417-1765
Mailing Address - Street 1:5450 MOUNTAIN TRL
Mailing Address - Street 2:DOUGLASVILLE
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1246
Mailing Address - Country:US
Mailing Address - Phone:404-417-1765
Mailing Address - Fax:404-417-1770
Practice Address - Street 1:VETERANS ADMINISTRATION
Practice Address - Street 2:1670 CLAIRMONT RD
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-417-1765
Practice Address - Fax:404-417-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215470282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital