Provider Demographics
NPI:1063501633
Name:VEGA, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:VEGA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:SUITE A2200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5040
Mailing Address - Fax:404-778-4346
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:SUITE A2200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-5040
Practice Address - Fax:404-778-4346
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA042471208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA78BBBCWMedicare ID - Type Unspecified
GAC22949001Medicare UPIN