Basic Information
| Provider Information | |||||||||
| NPI: | 1487260949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VINING | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | CALEB | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 MALL BLVD STE 202E | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123494945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 S RAILROAD ST | ||||||||
| Address2: | |||||||||
| City: | LENOX | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316377424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2299991778 | ||||||||
| FaxNumber: | 2954646122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2020 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN231071 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.