Healthcare Provider Details

I. General information

NPI: 1265508931
Provider Name (Legal Business Name): RONALD WILLIAM VARGO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WALTER WAY
FAYETTEVILLE GA
30214-3999
US

IV. Provider business mailing address

105 WALTER WAY
FAYETTEVILLE GA
30214-3999
US

V. Phone/Fax

Practice location:
  • Phone: 770-312-4900
  • Fax: 770-312-4900
Mailing address:
  • Phone: 770-312-4900
  • Fax: 770-312-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27371
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR008251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: