Healthcare Provider Details

I. General information

NPI: 1336643287
Provider Name (Legal Business Name): MAXWELL JOSEPH VOGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 09/11/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST STE 20
AUGUSTA GA
30901-2771
US

IV. Provider business mailing address

762 NUTTALL ST
EVANS GA
30809-0838
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-3401
  • Fax:
Mailing address:
  • Phone: 724-561-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number100595
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: