Basic Information
| Provider Information | |||||||||
| NPI: | 1649297292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VISHWANATH | ||||||||
| FirstName: | VINAI | ||||||||
| MiddleName: | MADHURE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3949 S COBB DR SE | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300806342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704385229 | ||||||||
| FaxNumber: | 7704384356 | ||||||||
| Practice Location | |||||||||
| Address1: | 3949 S COBB DR SE | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300806342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704385229 | ||||||||
| FaxNumber: | 7704384356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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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 | 207LA0401X | 055994 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207LP2900X | 055994 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 055994 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.