Healthcare Provider Details

I. General information

NPI: 1316689482
Provider Name (Legal Business Name): RANJITHA VASA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CHAFEE AVE
AUGUSTA GA
30904-5806
US

IV. Provider business mailing address

7 ELLSWORTH DR
WEST WINDSOR NJ
08550-3513
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-4434
  • Fax:
Mailing address:
  • Phone: 732-371-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number114285
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: