Provider Demographics
NPI:1689885501
Name:FIGUEROA, VIRGIL (CNP)
Entity type:Individual
Prefix:MR
First Name:VIRGIL
Middle Name:
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2432
Mailing Address - Country:US
Mailing Address - Phone:770-479-5535
Mailing Address - Fax:770-479-8821
Practice Address - Street 1:320 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2432
Practice Address - Country:US
Practice Address - Phone:770-479-5535
Practice Address - Fax:770-720-3294
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144625163WR0006X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003142145AMedicaid
GA20250I9205Medicare PIN
Q27118Medicare UPIN