Healthcare Provider Details

I. General information

NPI: 1891591939
Provider Name (Legal Business Name): KAREN JOSEPHINE VAGHEFI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 KENTONS LN
DULUTH GA
30097-8464
US

IV. Provider business mailing address

6070 KENTONS LN
DULUTH GA
30097-8464
US

V. Phone/Fax

Practice location:
  • Phone: 678-891-8673
  • Fax:
Mailing address:
  • Phone: 678-891-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN220000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: