Provider Demographics
NPI:1518784206
Name:GEORGIA WAR VETERANS HOME
Entity type:Organization
Organization Name:GEORGIA WAR VETERANS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:703-578-6030
Mailing Address - Street 1:2900 S QUINCY ST STE 888
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2233
Mailing Address - Country:US
Mailing Address - Phone:703-578-6030
Mailing Address - Fax:
Practice Address - Street 1:2249 VINSON HWY SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4807
Practice Address - Country:US
Practice Address - Phone:478-445-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STG INTERNATIONAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty