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NPI Code Detail

MEDICARE: LUIS RAFAEL VIZCARRA-FALLA MD

MEDICARE:   LUIS RAFAEL VIZCARRA-FALLA  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital
2207R00000XInternal Medicine Physician68630GA

General Provider Information

NPI Number : 1497029565
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS RAFAEL VIZCARRA-FALLA MD
Provider Business Mailing Address
First Line : 7082 ROSELAKE CIR
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30134-1680
Country : US
Telephone Number : 404-438-6568
Fax Number :
Provider Business Practice Location Address
First Line : 6825 JIMMY CARTER BLVD
Second Line : SUITE 1590
City : NORCROSS
State : GA
Zip : 30071-1228
Country : US
Telephone Number : 678-615-2565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2012
Last Update Date : 12/20/2013

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Directions to “ LUIS RAFAEL VIZCARRA-FALLA MD” Practice Location

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