Provider Demographics
NPI:1902354822
Name:ARNOLD, VIVIAN (CERT HAIR LOSS SPEC)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPEC
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERT HAIR LOSS SPEC
Mailing Address - Street 1:518 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3490
Mailing Address - Country:US
Mailing Address - Phone:404-787-3811
Mailing Address - Fax:
Practice Address - Street 1:518 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3490
Practice Address - Country:US
Practice Address - Phone:404-787-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL1954601311744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management