Individual
DR. JUSTIN MACKENZIE VINING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2418 E PLAZA DR, TALLAHASSEE, FL 32308-5301
(850) 629-4861
(850) 629-4859
Mailing address
PO BOX 746645, ATLANTA, GA 30374-6645
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
002992
GA
208000000X
Pediatrics Physician
ME126004
FL
2080P0202X
Pediatric Cardiology Physician
066664
GA
2080P0202X
Pediatric Cardiology Physician
Primary
ME126004
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066664
GA LICENSES
—
Enumeration date
06/25/2008
Last updated
01/08/2025
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