Individual
VINCENT T PENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
191 MEDICAL BOULEVARD, STOCKBRIDGE, GA 30281
(770) 991-1000
(770) 991-2088
Mailing address
191 MEDICAL BLVD, STOCKBRIDGE, GA 30281
(770) 991-1000
(770) 991-2088
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
014652
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245302165
BCBSGA PROVIDER NUMBER
GA
Enumeration date
11/15/2006
Last updated
09/26/2007
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