| Doctor Name: | DR. AGUSTIN V VITUALLA |
| NPI Number: | 1134217029 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 017177 |
| Business Practice Address: | 135 Hospital Dr Camden, TN - 38320 |
| Business Phone Number: | 7315842117 |
| Business Fax Number: | 7315843564 |
| Mailing Address: | Po Box 625, 135 Hospital Dr CAMDEN |
| State: | TN |
| Postal Code: | 38320 |
| Phone Number: | 7315842117 |
| Fax Number: | 7315843564 |
| NPI Enumeration Date: | 10/10/2006 |
| NPI Last Update Date: | 10/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 017177 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |