Healthcare Provider Details

I. General information

NPI: 1942316526
Provider Name (Legal Business Name): VINCENT ANTONIO NAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WHITTLESEY RD SUITE 200
COLUMBUS GA
31904-3099
US

IV. Provider business mailing address

2430 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4501
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-7700
  • Fax: 706-494-8800
Mailing address:
  • Phone: 706-494-7700
  • Fax: 706-494-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number040497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: