Provider Demographics
NPI:1366471914
Name:UMSTEAD, VIDA V (NP)
Entity type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:V
Last Name:UMSTEAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102321
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2321
Mailing Address - Country:US
Mailing Address - Phone:770-801-2500
Mailing Address - Fax:770-803-2121
Practice Address - Street 1:15 REINHARDT COLLEGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5259
Practice Address - Country:US
Practice Address - Phone:770-704-6988
Practice Address - Fax:770-720-8775
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN115864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN115864OtherGA LIC
FL307438200Medicaid