MEDICARE: DR. MADELAINE ODETTE SANTOS-VEGA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	74351	GA

General Provider Information

NPI Number	:	1790752228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADELAINE ODETTE SANTOS-VEGA M.D.

Provider Business Mailing Address
First Line	:	609 E LAMAR ST
Second Line	:
City	:	AMERICUS
State	:	GA
Zip	:	31709-3737
Country	:	US
Telephone Number	:	229-924-8636
Fax Number	:	229-924-8786

Provider Business Practice Location Address
First Line	:	609 EAST LAMAR STREET
Second Line	:
City	:	AMERICUS
State	:	GA
Zip	:	31709-3737
Country	:	US
Telephone Number	:	229-924-8636
Fax Number	:	229-924-8786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	05/31/2023

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