Provider Demographics
NPI:1417768664
Name:DRUMMOND VIRGIN, VANESSA (CFTS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DRUMMOND VIRGIN
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 CRESTVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-3265
Mailing Address - Country:US
Mailing Address - Phone:954-479-4958
Mailing Address - Fax:
Practice Address - Street 1:7151 CRESTVIEW DR SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-3265
Practice Address - Country:US
Practice Address - Phone:954-479-4958
Practice Address - Fax:770-784-7233
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1578556619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty