Provider Demographics
NPI:1376723619
Name:VENGOECHEA BARRIOS, JAIME ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ENRIQUE
Last Name:VENGOECHEA BARRIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON RD NE STE A1500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE # A1500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-5307
Practice Address - Country:US
Practice Address - Phone:404-778-8570
Practice Address - Fax:404-778-8562
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012772207R00000X, 207SG0201X
ARE-7386207SG0201X
GA74420207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine