=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285849448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTWANETTA DENISE VINSON RCP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 09/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 187 MOURY AVE SW 1607
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30315-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-457-7943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 187 MOURY AVE SW 1607
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30315-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-457-7943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 0117005266
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 006826
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 2006032814
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 1603395
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | YM012043
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 003916
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------