Provider Demographics
NPI:1821386574
Name:VINSON, DELANDRA S (CPM)
Entity Type:Individual
Prefix:MS
First Name:DELANDRA
Middle Name:S
Last Name:VINSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6093 QUEENS RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7261
Mailing Address - Country:US
Mailing Address - Phone:770-241-2078
Mailing Address - Fax:678-805-0513
Practice Address - Street 1:6093 QUEENS RIVER DR
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-7261
Practice Address - Country:US
Practice Address - Phone:770-241-2078
Practice Address - Fax:678-853-7915
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula