Basic Information
Provider Information
NPI: 1003805722
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VERNON
FirstName: ANDREW
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8147
Address2:  
City: COLUMBUS
State: GA
PostalCode: 319088147
CountryCode: US
TelephoneNumber: 7063202773
FaxNumber: 7065964226
Practice Location
Address1: 2122 MANCHESTER EXPY
Address2:  
City: COLUMBUS
State: GA
PostalCode: 31904
CountryCode: US
TelephoneNumber: 7063202773
FaxNumber: 7065964226
Other Information
ProviderEnumerationDate: 10/14/2005
LastUpdateDate: 05/30/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0200X0101254047VAN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RP1001X37412GAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RP1001X0101254047VAN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RP1001X24528TNN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RS0012X0101254047VAN Allopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine

ID Information
IDTypeStateIssuerDescription
100380572205VA MEDICAID


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