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General NPI Number Information
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NPI Number | 1598319287
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Entity Type | Organization
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Legal Business Name | VIBRANT FAMILY MEDICINE, P.C.
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 6667 VERNON WOODS DR STE A19
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City | ATLANTA
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State | GA
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Zip | 30328-3215
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Country | US
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Telephone | 404-396-1640
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Fax |
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Provider Business Mailing Address
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Address Line | 4903 HEATHERDALE LN
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City | ATLANTA
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State | GA
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Zip | 30360-1615
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Country | US
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Telephone | 404-396-1640
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Fax |
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. BRADFORD GOULD
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Credential | M.D.
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Telephone | 404-396-1640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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