NPIMap

Organization Active NPI

Vidro Industries, LLC

  • Family Medicine Physician
  • Villa Rica, GA
National Provider Identifier
1922346709
Registry record updated Jan 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
62989 Issued in GA
Legal business name
VIDRO INDUSTRIES, LLC
Practice address
20 Herrell Rd
Villa Rica, GA 30180-5527
Phone
(770) 456-3929
NPI assigned
Jan 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2013

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

Authorized official

Name
Dr. Richard Glass, M,D.NPI 1780820753
Title
President/Ceo
Phone
(404) 858-1063

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 62989 GA Primary

Addresses

Primary practice location

20 Herrell Rd
Villa Rica, GA 30180-5527

Mailing address

PO Box 1149
Villa Rica, GA 30180-6149
Phone (404) 858-1063

Other names 1

  • Vidro Health Industries Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359417600000",
    "number": "1922346709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1149",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301806149",
            "telephone_number": "404-858-1063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 HERRELL RD",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301805527",
            "telephone_number": "770-456-3929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDRO INDUSTRIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-29",
        "last_updated": "2013-01-29",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "404-858-1063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M,D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "62989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vidro Health Industries",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.