Individual
DR. AGUSTIN V VITUALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 HOSPITAL DR, CAMDEN, TN 38320
(731) 584-2117
(731) 584-3564
Mailing address
PO BOX 625, 135 HOSPITAL DR, CAMDEN, TN 38320
(731) 584-2117
(731) 584-3564
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
017177
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3021196
—
TN
Enumeration date
10/10/2006
Last updated
10/20/2011
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