Provider Demographics
NPI:1285849448
Name:VINSON, ANTWANETTA DENISE (RCP)
Entity Type:Individual
Prefix:MRS
First Name:ANTWANETTA
Middle Name:DENISE
Last Name:VINSON
Suffix:
Gender:F
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MOURY AVE SW
Mailing Address - Street 2:1607
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-3426
Mailing Address - Country:US
Mailing Address - Phone:404-457-7943
Mailing Address - Fax:
Practice Address - Street 1:187 MOURY AVE SW
Practice Address - Street 2:1607
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-3425
Practice Address - Country:US
Practice Address - Phone:404-457-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0117005266227800000X
GA006826227800000X
MO2006032814227800000X
KS1603395227800000X
PAYM012043227800000X
NY003916227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified