Provider Demographics
NPI:1902962046
Name:VALCIN, MARIE M
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:VALCIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SPRINGHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5260
Mailing Address - Country:US
Mailing Address - Phone:678-558-6146
Mailing Address - Fax:
Practice Address - Street 1:306 SPRINGHAVEN RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5260
Practice Address - Country:US
Practice Address - Phone:678-558-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution