Provider Demographics
NPI:1811030711
Name:TURNER, VICENTA R
Entity type:Individual
Prefix:
First Name:VICENTA
Middle Name:R
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 JESSE JEWELL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-6103
Mailing Address - Country:US
Mailing Address - Phone:770-536-3108
Mailing Address - Fax:770-536-2357
Practice Address - Street 1:1079 JESSE JEWELL PKWY SW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-6103
Practice Address - Country:US
Practice Address - Phone:770-536-3108
Practice Address - Fax:770-536-2357
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170101721768118183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA170101721768118OtherSTATE CERTIFICATION