| Veda Lara Llc | |
|
1530 Laurel Park Cir Ne Atlanta GA 30329-3217 | |
| (404) 447-9803 | |
| Not Available |
| Full Name | Veda Lara Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1530 Laurel Park Cir Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Stephen C Dudley (OWNER) |
| Authorized Official Contact | 4044479803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Veda Lara Llc 1530 Laurel Park Cir Ne Atlanta GA 30329-3217 Ph: (404) 447-9803 | Veda Lara Llc 1530 Laurel Park Cir Ne Atlanta GA 30329-3217 Ph: (404) 447-9803 |
| NPI Number | 1578183737 |
|---|---|
| Provider Enumeration Date | 04/17/2020 |
| Last Update Date | 04/17/2020 |
| Certification Date | 04/17/2020 |
| Medicare PECOS PAC ID | 9537590328 |
|---|---|
| Medicare Enrollment ID | O20200511003483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578183737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Stephen Christopher Dudley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316111412 PECOS PAC ID: 4880738475 Enrollment ID: I20160705000503 |
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