Basic Information
| Provider Information | |||||||||
| NPI: | 1467417410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENNON | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| OtherLastName: | LENNON | ||||||||
| OtherFirstName: | VIVIAN | ||||||||
| OtherMiddleName: | SAKER | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1619 MONTCLIFF CT | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042283723 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4166 BUFORD HWY | ||||||||
| Address2: | STE 1102 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047858150 | ||||||||
| FaxNumber: | 4047858173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 043121 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A71620 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.