Healthcare Provider Details

I. General information

NPI: 1447308739
Provider Name (Legal Business Name): JALLEH VAFAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TURNER MCCALL BLVD SW
ROME GA
30165-5621
US

IV. Provider business mailing address

420 E 2ND AVE SUITE 103
ROME GA
30161-3224
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-5000
  • Fax: 706-509-4608
Mailing address:
  • Phone: 706-509-3278
  • Fax: 706-509-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number045019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: