Healthcare Provider Details

I. General information

NPI: 1154494508
Provider Name (Legal Business Name): VINCENT HO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD BUILDING 1300
MARIETTA GA
30062-1266
US

IV. Provider business mailing address

3225 SHALLOWFORD RD BUILDING 1300
MARIETTA GA
30062-1266
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax: 678-560-7185
Mailing address:
  • Phone: 678-560-7160
  • Fax: 678-560-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number44488
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44488
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: