Healthcare Provider Details

I. General information

NPI: 1306820832
Provider Name (Legal Business Name): JOHN G VACHTSEVANOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3861
US

IV. Provider business mailing address

1240 JESSE JEWELL PKWY STE 300
GAINESVILLE GA
30501
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-7202
  • Fax: 678-450-3778
Mailing address:
  • Phone: 770-532-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number046269
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: