Provider Demographics
NPI:1346361912
Name:ZYNIA PUA-VINES, MD, PC
Entity Type:Organization
Organization Name:ZYNIA PUA-VINES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZYNIA
Authorized Official - Middle Name:PUA
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-443-2535
Mailing Address - Street 1:501 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5301
Mailing Address - Country:US
Mailing Address - Phone:205-443-2535
Mailing Address - Fax:
Practice Address - Street 1:501 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5301
Practice Address - Country:US
Practice Address - Phone:205-443-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.27514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherEIN