Provider Demographics
NPI:1437142569
Name:MAFFEI, VINCENT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOSEPH
Last Name:MAFFEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5902
Mailing Address - Country:US
Mailing Address - Phone:706-208-1144
Mailing Address - Fax:706-208-9668
Practice Address - Street 1:784 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5902
Practice Address - Country:US
Practice Address - Phone:706-208-1144
Practice Address - Fax:706-208-9668
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25227202K00000X
GA025227208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00505447AMedicaid
D21214Medicare UPIN
GA00505447AMedicaid