Provider Demographics
NPI:1649264177
Name:MOLINARI, VINCENT G (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:G
Last Name:MOLINARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:220 J L WHITE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4893
Mailing Address - Country:US
Mailing Address - Phone:706-692-3539
Mailing Address - Fax:706-692-9364
Practice Address - Street 1:220 J L WHITE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4893
Practice Address - Country:US
Practice Address - Phone:706-692-3539
Practice Address - Fax:706-692-9364
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA22603207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00221592KMedicaid
GA00221592GMedicaid
GA00221592KMedicaid
GAD30276Medicare UPIN