Provider Demographics
NPI:1013411255
Name:ARIENTYL, VANESSA (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ARIENTYL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 JESSE HILL JR. DRIVE SOUTHEAST
Mailing Address - Street 2:GLENN MEMORIAL BUILDING, 3RD FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-251-8915
Mailing Address - Fax:404-523-3931
Practice Address - Street 1:69 JESSE HILL JR. DRIVE SOUTHEAST
Practice Address - Street 2:GLENN MEMORIAL BUILDING, 3RD FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-251-8915
Practice Address - Fax:404-523-3931
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96957208600000X, 2086S0127X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program