Provider Demographics
NPI:1376758029
Name:VINSON, JANELL THOMPSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JANELL
Middle Name:THOMPSON
Last Name:VINSON
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 1:1122 E MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2348
Mailing Address - Country:US
Mailing Address - Phone:601-656-9900
Mailing Address - Fax:601-656-9933
Practice Address - Street 1:625 UNITED DR STE 120
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-358-6892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2118208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN