Provider Demographics
NPI:1841515780
Name:DENISE C. DE VERANEZ, M.D., P.C.
Entity type:Organization
Organization Name:DENISE C. DE VERANEZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:DE VERANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-507-1414
Mailing Address - Street 1:110 LANG DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3894
Mailing Address - Country:US
Mailing Address - Phone:770-507-1414
Mailing Address - Fax:770-507-5150
Practice Address - Street 1:175 COUNTRY CLUB DR
Practice Address - Street 2:BLDG. 100, STE. C
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9054
Practice Address - Country:US
Practice Address - Phone:770-507-1414
Practice Address - Fax:770-507-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-04
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty