VIDRO INDUSTRIES, LLC (NPI# 1427355106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427355106 |
| Entity Type | Organization |
| Organization Name | VIDRO INDUSTRIES, LLC |
| Practice Address |
20 Herrell Rd Villa Rica GA 30180-5527 |
| Mailing Address |
Po Box 1149 Villa Rica GA 30180-6149 |
| Practice Telephone | 7704564691 |
| Mailing Telephone | 7704564691 |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2013-06-27 |
| Authorized Official Name | DR. RICHARD GLASS JR. (CEO) |
| Authorized Official Telephone | 7704564691 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 062989 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 344112558A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922346709 | Vidro Industries, LLC | Family Medicine | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2013-01-29 |
| Street Address |
20 HERRELL RD |
| City | VILLA RICA |
| State | GA |
| Zip Code | 30180-5527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679530430 | Golden Barnett IIi | Psychiatry & Neurology | 20 Herrell Rd, Villa Rica, GA 30180 | 2006-04-27 |
| 1174151138 | John Brian Gibson | Counselor | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2020-03-27 |
| 1386276483 | Chelsesa Arissa Pounds | Counselor | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2020-02-06 |
| 1013554534 | Allyson Moffatt | Counselor | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2019-12-03 |
| 1295399988 | Kayla Michelle Arnold | Counselor | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2019-04-28 |
| 1083189328 | Thomas Stuckey | Nurse Practitioner | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2018-10-12 |
| 1922491695 | Arun K Kantamneni Md, Inc. | Psychiatry & Neurology | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2015-03-05 |
| 1306257126 | Camilo Leal | Psychiatry & Neurology | 20 Herrell Rd, Villa Rica, GA 30180 | 2014-05-14 |
| 1922346709 | Vidro Industries, LLC | Family Medicine | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2013-01-29 |
| 1073862751 | Amber Nickolina Tidwell | Nurse Practitioner | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2012-09-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174161624 | Crucible Communication Therapy LLC | Speech-Language Pathologist | 9765 Walnut Grove Trail, Villa Rica, GA 30180 | 2019-12-16 |
| 1366802845 | Medic-pearl, LLC | Ambulance | 1108 Charter Oak Ct, Villa Rica, GA 30180 | 2016-02-26 |
| 1396138368 | Josette Etienne | Nurse Practitioner | 403 Permian Way Suite A, Villa Rica, GA 30180 | 2015-03-13 |
| 1447690516 | Judith L.m. Thigpen | Nurse Practitioner | 736 Highway 78 West, Minute Clinic, Villa Rica, GA 30180 | 2013-07-03 |
| 1477890168 | Wesley Douglas Mckenzie | Pharmacist | 2500 Mirror Lake Blvd, Villa Rica, GA 30180 | 2013-01-15 |
| 1497005359 | Malika Remie Rajendra | Optometrist | 600 Hwy 61, Villa Rica, GA 30180 | 2012-09-18 |
| 1972876449 | Catherine Elaine Tyson | Pharmacist | 601 Dallas Road, Villa Rica, GA 30180 | 2012-02-14 |
| 1619262433 | Villa Rica Rx LLC | Pharmacy | 222 West Wilson Street, Villa Rica, GA 30180 | 2011-06-09 |
| 1851602874 | Jules Chopin Sybert | Nurse Practitioner | 736 W. Bankhead Hwy, Villa Rica, GA 30180 | 2010-06-24 |
| 1487984019 | Lisa Wood | Occupational Therapy Assistant | 1207 Woods Walk, Villa Rica, GA 30180 | 2010-01-04 |
| Find all providers in zip 30180 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255787651 | Henry Charles Guthery IIi | Family Medicine | 809 W Bankhead Hwy Ste D, Villa Rica, GA 30180-1520 | 2016-05-04 |
| 1043432164 | James Larry Boss | Family Medicine | 517 Leslie Dr, Villa Rica, GA 30180-2406 | 2007-05-02 |
| 1093800823 | Ejese Healthcare, PC | Family Medicine | 125 Commons Way Ste 203, Villa Rica, GA 30180-7041 | 2006-10-04 |
| 1518932185 | Merna Michelle Vera | Family Medicine | 403 Permian Way, Suite A, Villa Rica, GA 30180-3252 | 2006-02-17 |
| 1083688873 | Virginia H Price | Family Medicine | 705 Dallas Hwy Ste 101, Villa Rica, GA 30180-1243 | 2006-02-16 |
| 1770554446 | Ewane Ngone | Family Medicine | 1002 Overlook Drive, Villa Rica, GA 30180-5804 | 2006-01-30 |
| 1326022492 | India C. Williams | Family Medicine | 401 Permian Way, Suite A, Villa Rica, GA 30180-3253 | 2005-12-02 |
| 1144784679 | Nova Medical Services, LLC | Family Medicine | 601 Dallas Hwy, Villa Rica, GA 30180-1202 | 2019-01-29 |
| 1922346709 | Vidro Industries, LLC | Family Medicine | 20 Herrell Rd, Villa Rica, GA 30180-5527 | 2013-01-29 |
| 1700171261 | Saman Razzak | Family Medicine | 101 Quartz Dr, Suite 201, Villa Rica, GA 30180-3255 | 2011-06-13 |
| Find all providers in VILLA RICA | ||||
| City | VILLA RICA |
| Zip Code | 30180 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.