Organization
DEAVMED L.L.C
Active
Other names
Vitality Springs Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD DEAVENS MD (OWNER/MEMBER)
(770) 925-5884
Entity
Organization
Contact information
Practice address
3915 CASCADE RD SW STE T-90, ATLANTA, GA 30331-8660
(770) 925-5884
(888) 440-7722
Mailing address
1481 BOURDON BELL DR SE, CONYERS, GA 30013-7459
(770) 925-5884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/24/2019
Last updated
12/19/2019
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