Healthcare Provider Details

I. General information

NPI: 1285849448
Provider Name (Legal Business Name): ANTWANETTA DENISE VINSON RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 MOURY AVE SW 1607
ATLANTA GA
30315-3425
US

IV. Provider business mailing address

187 MOURY AVE SW 1607
ATLANTA GA
30315-3426
US

V. Phone/Fax

Practice location:
  • Phone: 404-457-7943
  • Fax:
Mailing address:
  • Phone: 404-457-7943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number0117005266
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number006826
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2006032814
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number1603395
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberYM012043
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number003916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: