Basic Information
Provider Information
NPI: 1558724989
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VINSON
FirstName: KALIE
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5780 PEACHTREE DUNWOODY RD STE 300
Address2:  
City: ATLANTA
State: GA
PostalCode: 303421513
CountryCode: US
TelephoneNumber: 4043038035
FaxNumber: 4043031325
Practice Location
Address1: 5780 PEACHTREE DUNWOODY RD STE 320
Address2:  
City: ATLANTA
State: GA
PostalCode: 303421575
CountryCode: US
TelephoneNumber: 0425629434
FaxNumber: 4042566027
Other Information
ProviderEnumerationDate: 04/02/2016
LastUpdateDate: 10/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0000X86011GAY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics

No ID Information.


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