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General NPI Number Information
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NPI Number | 1649559998
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Entity Type | Individual
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Provider Name | ANGIE MICHELLE VINES NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 2000 10TH AVE SUITE 410
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City | COLUMBUS
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State | GA
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Zip | 31901-3700
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Country | US
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Telephone | 706-653-4615
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Fax | 706-653-4618
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Provider Business Mailing Address
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Address Line | 2000 10TH AVE SUITE 410
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City | COLUMBUS
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State | GA
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Zip | 31901-3700
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Country | US
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Telephone | 706-653-4615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN214290
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License Number State | GA
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