Healthcare Provider Details

I. General information

NPI: 1952585424
Provider Name (Legal Business Name): VINAY NAGARAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW
SUWANEE GA
30024-4651
US

IV. Provider business mailing address

1325 SATELLITE BLVD NW
SUWANEE GA
30024-4651
US

V. Phone/Fax

Practice location:
  • Phone: 678-263-3080
  • Fax: 678-496-9863
Mailing address:
  • Phone: 678-263-3080
  • Fax: 678-496-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number058297
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: