Healthcare Provider Details

I. General information

NPI: 1164135547
Provider Name (Legal Business Name): VINNYS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MAIN ST STE A8
ALPHARETTA GA
30009-1957
US

IV. Provider business mailing address

3980 CARISSA TRCE
CUMMING GA
30040-6174
US

V. Phone/Fax

Practice location:
  • Phone: 470-560-7449
  • Fax:
Mailing address:
  • Phone: 678-488-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENTIA ADJEI
Title or Position: OWNER
Credential: NP
Phone: 678-488-2532