Provider Demographics
NPI:1417316472
Name:VATZAKAS, ALEXANDRA ATHENA (AGACNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:ATHENA
Last Name:VATZAKAS
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Gender:F
Credentials:AGACNP-BC
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-422-1372
Mailing Address - Fax:770-423-9651
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 160
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-422-1372
Practice Address - Fax:770-423-9651
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2019-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA241190363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care