| Vidro Industries, Llc | |
|
20 Herrell Rd Villa Rica GA 30180-5527 | |
| (770) 456-4691 | |
| Not Available |
| Full Name | Vidro Industries, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 20 Herrell Rd, Villa Rica, Georgia |
| Authorized Official Name and Position | Richard Glass (CEO) |
| Authorized Official Contact | 7704564691 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vidro Industries, Llc Po Box 1149 Villa Rica GA 30180-6149 Ph: (770) 456-4691 | Vidro Industries, Llc 20 Herrell Rd Villa Rica GA 30180-5527 Ph: (770) 456-4691 |
| NPI Number | 1427355106 |
|---|---|
| Provider Enumeration Date | 02/16/2011 |
| Last Update Date | 06/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427355106 | NPI | - | NPPES |
| 344112558A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 062989 (Georgia) | Primary |
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