Healthcare Provider Details

I. General information

NPI: 1730716846
Provider Name (Legal Business Name): KAREN VEGA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PACES FERRY RD SE STE 500
ATLANTA GA
30339-5714
US

IV. Provider business mailing address

3280 HOWELL MILL RD NW STE 336
ATLANTA GA
30327-4111
US

V. Phone/Fax

Practice location:
  • Phone: 678-266-9678
  • Fax:
Mailing address:
  • Phone: 678-266-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number95661
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: