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NPI 1194109686 · General Practice Physician · Suwanee, GA
Provider details
- NPI number
- 1194109686
- Entity type
- Organization
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Vinson Disanto, Medical Director(866) 397-2104
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(73/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1325 Satellite Blvd Nw
Suwanee, GA 30024-4651
Phone: (866) 397-2104
Street-level locationGet directions
Mailing address
1325 Satellite Blvd Nw
Suwanee, GA 30024-4651
Registry dates
- Enumerated
- 2015-07-14
- Last updated
- 2015-07-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.