Provider Demographics
NPI:1891786497
Name:VAYNER, GALINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:
Last Name:VAYNER
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:PO BOX 769609
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8224
Mailing Address - Country:US
Mailing Address - Phone:404-385-0160
Mailing Address - Fax:404-365-0751
Practice Address - Street 1:6330 PRIMROSE HILL CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4544
Practice Address - Country:US
Practice Address - Phone:404-385-0160
Practice Address - Fax:404-365-0751
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000821928FMedicaid
GA1609816123OtherGEORGIA CLINIC, PC GROUP NPI #
G90439Medicare UPIN
GA1609816123OtherGEORGIA CLINIC, PC GROUP NPI #