Provider Demographics
NPI:1225063308
Name:VINCENT, ROBERT N (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:VINCENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2835 BRANDYWINE RD
Mailing Address - Street 2:#300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:404-256-2593
Mailing Address - Fax:678-547-1494
Practice Address - Street 1:5455 MERIDIAN MARK RD
Practice Address - Street 2:STE 530
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-256-2593
Practice Address - Fax:678-547-1494
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0298132080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00349951BMedicaid
37BDBWJMedicare ID - Type Unspecified
GA00349951BMedicaid