Basic Information
| Provider Information | |||||||||
| NPI: | 1326786989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANIL | ||||||||
| FirstName: | VISHWANATH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 SOUTH 8TH STREET | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702282721 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WELLSTAR SPALDING REGIONAL HOSPITAL | ||||||||
| Address2: | 608 S 8TH STREET | ||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702282721 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2022 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.