MEDICARE: VININGS MEDICAL CENTER, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	052228	GA

General Provider Information

NPI Number	:	1740257435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VININGS MEDICAL CENTER, P.C.

Provider Business Mailing Address
First Line	:	2451 CUMBERLAND PKWY SE
Second Line	:	SUITE 3541
City	:	ATLANTA
State	:	GA
Zip	:	30339-6136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4375 COBB PKWY
Second Line	:	SUITE A
City	:	ATLANTA
State	:	GA
Zip	:	30339-3811
Country	:	US
Telephone Number	:	770-955-9477
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANITA SMITH
Credential	:	M.D.
Telephone Number	:	770-955-9477

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	08/22/2020

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