# VINA HEALTH CARE CLINIC CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VINA HEALTH CARE CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487634648
- **Authorized official:** MS. LY DAM (OFFICE MANAGER)
- **Authorized official phone:** (404) 366-8822

## Contact information

- **Practice address:** 4487 JONESBORO RD, FOREST PARK, GA 30297-4316
- **Practice address phone:** (404) 366-8822
- **Practice address fax:** (404) 366-8824
- **Mailing address:** 4487 JONESBORO RD, FOREST PARK, GA 30297-4316
- **Mailing address phone:** (404) 366-8822
- **Mailing address fax:** (404) 366-8824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 040894 | GA | Yes |

## Other

- **Enumeration date:** 01/21/2006
- **Last updated:** 12/08/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000766884A | — | GA |