Provider Demographics
NPI:1275767501
Name:VINSON, MOHABE ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MOHABE
Middle Name:ANTHONY
Last Name:VINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N BAYSHORE DR
Mailing Address - Street 2:APT. 5002
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3001
Mailing Address - Country:US
Mailing Address - Phone:740-446-5415
Mailing Address - Fax:740-446-5958
Practice Address - Street 1:4181 HOSPITAL DR NE STE 303
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-784-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.124359208800000X
GA86576208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810027938Medicaid
OH0109962Medicaid
WV3810027938Medicaid