Individual
DR. BENNIE RAY VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2080 CHAMBLISS AVE NW, CLEVELAND, TN 37311-3894
(423) 472-6219
Mailing address
9308 PINE RIDGE RD, OOLTEWAH, TN 37363-8055
(423) 290-8792
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
055466
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52153553002
BCBS-GA PROVIDER ID #
GA
Enumeration date
05/10/2006
Last updated
07/09/2007
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