MEDICARE: DAVID E VINCENT MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	053627	GA

General Provider Information

NPI Number	:	1104050632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID E VINCENT MD PC

Provider Business Mailing Address
First Line	:	PO BOX 20303
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-8303
Country	:	US
Telephone Number	:	912-634-1050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2465 DEMERE RD
Second Line	:	SUITE 209
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-1630
Country	:	US
Telephone Number	:	912-634-1050
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	DAVID E VINCENT
Credential	:	MD
Telephone Number	:	912-399-1866

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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