Individual
VANITCHA R PINTAVORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
418 TOWN PARK BLVD, SUITE 1A, EVANS, GA 30809-3091
(706) 650-1662
(706) 854-2131
Mailing address
418 TOWN PARK BLVD, SUITE 1A, EVANS, GA 30809-3091
(706) 650-1662
(706) 854-2131
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
048291
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000894154D
—
GA
05
—
G48291
—
SC
Enumeration date
06/01/2005
Last updated
07/11/2008
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