Basic Information
| Provider Information | |||||||||
| NPI: | 1649264177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLINARI | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 J L WHITE DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | JASPER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301434893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066923539 | ||||||||
| FaxNumber: | 7066929364 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 J L WHITE DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | JASPER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301434893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066923539 | ||||||||
| FaxNumber: | 7066929364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 22603 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00221592K | 05 | GA | MEDICAID | 00221592G | 05 | GA | MEDICAID |