Provider Demographics
NPI:1609166875
Name:VINING, ODELL GEORGE JR (PHD)
Entity Type:Individual
Prefix:
First Name:ODELL
Middle Name:GEORGE
Last Name:VINING
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 12TH ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2462
Mailing Address - Country:US
Mailing Address - Phone:706-225-0322
Mailing Address - Fax:706-225-0321
Practice Address - Street 1:233 12TH ST
Practice Address - Street 2:SUITE 901
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2462
Practice Address - Country:US
Practice Address - Phone:706-225-0322
Practice Address - Fax:706-225-0321
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003434103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist