Provider Demographics
NPI:1336230465
Name:VINSANT, GEORGE O'NEAL (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:O'NEAL
Last Name:VINSANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E. CENTRAL AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766
Mailing Address - Country:US
Mailing Address - Phone:423-907-1680
Mailing Address - Fax:423-907-1684
Practice Address - Street 1:919 E. CENTRAL AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766
Practice Address - Country:US
Practice Address - Phone:423-907-1680
Practice Address - Fax:423-907-1684
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD181282086S0129X
TN0000018128208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000018128OtherMEDICAL LICENSE
TN4052243OtherBLUE CROSS BLUE SHIELD
TN320052634OtherTAX ID
TNBV1388936OtherDEA NUMBER
TN4052243OtherBLUE CROSS BLUE SHIELD
TNB51894Medicare UPIN