Healthcare Provider Details

I. General information

NPI: 1154553527
Provider Name (Legal Business Name): LAURA IRENE VEGH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE RM T5L66
ATLANTA GA
30322-5085
US

IV. Provider business mailing address

909 EAGLES LANDING PKWY SUITE 140-214
STOCKBRIDGE GA
30281-7247
US

V. Phone/Fax

Practice location:
  • Phone: 949-677-7830
  • Fax:
Mailing address:
  • Phone: 678-604-1053
  • Fax: 678-604-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number5667
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number5667
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: