Agustin V Vitualla, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

017177 Issued in TN

Practice address

135 Hospital Dr
Camden, TN 38320

Phone

(731) 584-2117

Fax

(731) 584-3564

NPI assigned

Oct 10, 2006

Last updated

Oct 20, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Behavioral Medicine, PLLC

  • Psychiatry Physician
  • Paris, TN
  • NPI 1366620643
  NPD (past)
• Thornburg Family Medical Clinic, Inc

  • Primary Care Clinic/Center
  • Camden, TN
  • NPI 1386951101
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1134217029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 625",
            "address_2": "135 HOSPITAL DR",
            "city": "CAMDEN",
            "state": "TN",
            "postal_code": "38320",
            "telephone_number": "731-584-2117",
            "fax_number": "731-584-3564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 HOSPITAL DR",
            "city": "CAMDEN",
            "state": "TN",
            "postal_code": "38320",
            "telephone_number": "731-584-2117",
            "fax_number": "731-584-3564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITUALLA",
        "first_name": "AGUSTIN",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "017177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leigh Danielle Sturdivant, DPH
• Thornburg Family Medical Clinic, Inc
• Kristie Lynn Threet, R.N.
• Jessica Toombs
• Cristie Anne Vibbert, FNP-BC
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0738)
• Wal-Mart Stores East, LP (Vision Center 30-0738)
• Bobbie Walker, FNP-C
• Janet Warren, RD
• Victoria Watson, MD

• General Practice Physician in Camden, TN
• Providers in Camden, TN by specialty
• General Practice Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.