Individual
MR. VADIM PETROV-KONDRATOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
604 W OGLETHORPE HWY, HINESVILLE, GA 31313-4415
(912) 910-3777
(912) 292-0005
Mailing address
604 W OGLETHORPE HWY, HINESVILLE, GA 31313-4415
(912) 910-3777
(912) 292-0005
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
88065
GA
208VP0014X
Interventional Pain Medicine Physician
Primary
88065
GA
208VP0014X
Interventional Pain Medicine Physician
E10674
AR
Other
Enumeration date
03/31/2012
Last updated
05/28/2025
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