Individual provider Active NPI

Imani D. Vannoy, M.D.

  • Internal Medicine Physician
  • Marietta, GA
National Provider Identifier
1376596783
Registry record updated Aug 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
024225 Issued in GA
Practice address
741 Chance Rd
Marietta, GA 30066-3711
Phone
(770) 977-5355
Fax
(770) 973-8497
NPI assigned
May 18, 2006
Last updated
Aug 10, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 024225 GA Primary

Addresses

Primary practice location

741 Chance Rd
Marietta, GA 30066-3711

Mailing address

741 Chance Rd
Marietta, GA 30066-3711
Phone (770) 977-5355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060612000110 GA Practitioner - Internal Medicine 7618989625 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Harvard Medical School, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

390 Ernest W Barrett Pkwy NW
Suite 4
Kennesaw, GA 30144-4989
Phone (770) 426-9945

741 Chance Rd
Marietta, GA 30066-3711
Phone (770) 977-5355

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
024225GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marietta Medical Group CurrentSince Nov 21, 2005 Accepting new patients

Locations

741 Chance Rd
Marietta, GA 30066
Phone (770) 977-5355

Organizations & group practices 1

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249862400000",
    "number": "1376596783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 CHANCE RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663711",
            "telephone_number": "770-977-5355",
            "fax_number": "770-973-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 CHANCE RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663711",
            "telephone_number": "770-977-5355",
            "fax_number": "770-973-8497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANNOY",
        "first_name": "IMANI",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2009-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "024225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.