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General NPI Number Information
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NPI Number | 1740257435
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Entity Type | Organization
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Legal Business Name | VININGS MEDICAL CENTER, P.C.
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4375 COBB PKWY SUITE A
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City | ATLANTA
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State | GA
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Zip | 30339-3811
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Country | US
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Telephone | 770-955-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 2451 CUMBERLAND PKWY SE SUITE 3541
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City | ATLANTA
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State | GA
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Zip | 30339-6136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANITA SMITH
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Credential | M.D.
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Telephone | 770-955-9477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 052228
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License Number State | GA
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