Individual
VIRGINIA HICKS TAYLOR MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
265 BOULEVARD NE, ATLANTA, GA 30312-1208
(404) 730-1650
Mailing address
537 FLINT RIVER COURT, JONESBORO, GA 30238
(770) 472-9917
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RN178733
GA
Other
Enumeration date
12/07/2007
Last updated
12/07/2007
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