1629188222 NPI number — RAMUNAS J VIGELIS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629188222 NPI number — RAMUNAS J VIGELIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIGELIS
Provider First Name:
RAMUNAS
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629188222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 ROSELANE ST NW
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-7902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-259-5226
Provider Business Mailing Address Fax Number:
267-321-2044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 SAINT VINCENTS DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-212-9435
Provider Business Practice Location Address Fax Number:
205-212-3229
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2627 . This is a "LICENSE #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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