Provider Demographics
NPI:1982064895
Name:VICTORY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:VICTORY HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:N
Authorized Official - Last Name:AMADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-274-0001
Mailing Address - Street 1:4 E WASHINGTON ST STE B6
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1933
Mailing Address - Country:US
Mailing Address - Phone:470-274-0001
Mailing Address - Fax:470-274-0002
Practice Address - Street 1:4 E WASHINGTON ST STE B6
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1933
Practice Address - Country:US
Practice Address - Phone:470-274-0001
Practice Address - Fax:470-274-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022-R-1503253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care