Healthcare Provider Details

I. General information

NPI: 1205924073
Provider Name (Legal Business Name): JOHN VAZQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE BOX M-7
ATLANTA GA
30322-1064
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD SUITE 500
ATLANTA GA
30342-1764
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6382
  • Fax: 404-778-5495
Mailing address:
  • Phone: 678-843-7990
  • Fax: 678-843-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number054950
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: