Healthcare Provider Details

I. General information

NPI: 1881154086
Provider Name (Legal Business Name): RICK DANIEL VAVOLIZZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD BLDG STE 150
SANDY SPRINGS GA
30342-1701
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD BLDG STE 150
SANDY SPRINGS GA
30342-1701
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3307
  • Fax: 404-778-1279
Mailing address:
  • Phone: 404-778-3307
  • Fax: 404-778-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number111897
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: