Virginia Lake

NPI #1720738867 in Dalton, Georgia

Provider Information

NPI Number: 1720738867
Entity Type: Individual
Name: Virginia Lake
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Nurse Practitioner
Enumeration Date: Mar 23, 2022
Last Updated: Mar 23, 2022

Practice Location

Address: 812 THORNTON PL
City: Dalton
State: Georgia
ZIP Code: 30720-5228
Phone: (404) 578-7393

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Registered Nurse	163W00000X
Nurse Practitioner	363L00000X	Primary

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