| Organization Name: | VINA HEALTH CARE CLINIC CORPORATION |
| NPI Number: | 1487634648 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LY DAM (OFFICE MANAGER) |
| Mailing Address: | 4487 Jonesboro Rd Forest Park |
| State: | GA US |
| Postal Code: | 302974316 |
| Phone Number: | 4043668822 |
| Fax Number: | 4043668824 |
| NPI Enumeration Date: | 01/21/2006 |
| NPI Last Update Date: | 12/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 040894 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |