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VINCENT F POLVINALE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
4575 NORTH SHALLOWFORD ROAD, DUNWOODY, GA 30338
(770) 454-4286
(770) 454-4065
Mailing address
PO BOX 70128, MARIETTA, GA 30007-0128
(770) 578-1800
(770) 578-6168

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN096241
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000550624C
GA
Enumeration date
05/24/2006
Last updated
01/04/2013
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