VIRGINIA LAKE

DALTON, GA
NPI1720738867
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: GA  225227)
Additional Taxonomies163W00000X Registered Nurse
(Licence: GA  225227)
Enumeration Date2022-03-23
Last Update Date2022-03-23
Business Address
VIRGINIA LAKE
812 THORNTON PL
DALTON, GA 30720-5228
Phone number: 404-578-7393
Mailing Address
VIRGINIA LAKE
812 THORNTON PL
DALTON, GA 30720-5228
Phone number: