Organization
VANITCHA R PINTAVORN
Active
Other names
AUGUSTA FAMILY ALLERGY & IMMUNOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VANITCHA R PINTAVORN MD (OWNER)
(706) 650-1662
Entity
Organization
Contact information
Practice address
418 TOWN PARK BLVD, STE 1A, EVANS, GA 30809-3090
(706) 650-1662
(706) 854-2131
Mailing address
418 TOWN PARK BLVD, STE 1A, EVANS, GA 30809-3090
(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
01
—
52837117
BCBS
GA
05
—
G48291
—
SC
Enumeration date
06/10/2006
Last updated
07/11/2008
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