Healthcare Provider Details

I. General information

NPI: 1184149130
Provider Name (Legal Business Name): DEVIN M. VAISHNANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 POPLAR RD
NEWNAN GA
30265-1618
US

IV. Provider business mailing address

745 POPLAR RD
NEWNAN GA
30265-1618
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax:
Mailing address:
  • Phone: 770-400-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number86574
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86574
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: