Healthcare Provider Details

I. General information

NPI: 1437063195
Provider Name (Legal Business Name): JONATHAN PARKER VINCENT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 BOLTON RD NW
ATLANTA GA
30318-1322
US

IV. Provider business mailing address

2897 N DRUID HILLS RD NE # 201
ATLANTA GA
30329-3924
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-8855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036545
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: