Imani D. Vannoy, M.D.
Individual provider Active NPI Internal Medicine Physician · Marietta, GA
NPI 1376596783 · NPPES record last updated Aug 10, 2009
Key facts
- NPI
- 1376596783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 024225 (GA)
- Practice address
- 741 Chance Rd
Marietta, GA 30066-3711 - Phone
- (770) 977-5355
- Fax
- (770) 973-8497
- NPI assigned
- May 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 4
Medicare Care Compare profile
- 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 Inc
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
- Wellstar Home Health, LLC
- Wellstar Kennestone Regional Medical Center
- Wellstar Cobb Medical Center
- Wellstar Windy Hill Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060612000110 | GA | Practitioner - Internal Medicine | 7618989625 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024225 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marietta Medical Group | Current |
Accepting new patients |
Locations
741 Chance Rd
Marietta, GA 30066
Phone (770) 977-5355
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 024225 | GA | Yes |
Addresses
Primary practice location
741 Chance Rd
Marietta, GA 30066-3711
Mailing address
741 Chance Rd
Marietta, GA 30066-3711
Phone (770) 977-5355
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000356617A | Medicaid | GA |
Other providers in Marietta, GA
- Thomas Vangalder
- Surya N Vangapandu
- Vanguard Healthcare Services
- Jennifer Diane Vann
- Sotheavy Vann
- Alyssa Vanryne
- Kaitlyn Beth Vanstrien
- Helen Barnes Vantine
- Tara Vanvranken
- Marguerite Marie Vardman
All providers in Marietta, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.