Healthcare Provider Details

I. General information

NPI: 1699028696
Provider Name (Legal Business Name): VINCENT BERNARD FARRELL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5239 HIGHWAY 278 NE
COVINGTON GA
30014-2671
US

IV. Provider business mailing address

1471 GRANITE SPRINGS DR
CONYERS GA
30094-5200
US

V. Phone/Fax

Practice location:
  • Phone: 678-660-5106
  • Fax: 678-660-5107
Mailing address:
  • Phone: 317-607-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP244839
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28129625A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: