Provider Demographics
NPI:1013750322
Name:MCPHERSON, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-7503
Mailing Address - Country:US
Mailing Address - Phone:478-457-4730
Mailing Address - Fax:
Practice Address - Street 1:342 N LAKE DR
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-7503
Practice Address - Country:US
Practice Address - Phone:478-457-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor