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General NPI Number Information
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NPI Number | 1104050632
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Entity Type | Organization
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Legal Business Name | DAVID E VINCENT MD PC
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 2465 DEMERE RD SUITE 209
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-1630
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Country | US
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Telephone | 912-634-1050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20303
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-8303
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Country | US
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Telephone | 912-634-1050
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DAVID E VINCENT
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Credential | MD
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Telephone | 912-399-1866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 053627
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License Number State | GA
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