Basic Information
| Provider Information | |||||||||
| NPI: | 1366061566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | PAULA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4002 LUCAS LN | ||||||||
| Address2: | |||||||||
| City: | ELLENWOOD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302942070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3219456577 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5505 PEACHTREE DUNWOODY RD STE 600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4044251079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | RN9500678 | FL | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.