Provider Demographics
NPI:1467417410
Name:LENNON, VIVIAN S (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:S
Last Name:LENNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:SAKER
Other - Last Name:LENNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1619 MONTCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-228-3723
Mailing Address - Fax:
Practice Address - Street 1:4166 BUFORD HWY
Practice Address - Street 2:STE 1102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345
Practice Address - Country:US
Practice Address - Phone:404-785-8150
Practice Address - Fax:404-785-8173
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043121208000000X
CAA71620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics