Provider Demographics
NPI:1437496866
Name:VITACCA, ROCCO JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:JOHN
Last Name:VITACCA
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 1:506 RIVER SOUND LN
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0727
Mailing Address - Country:US
Mailing Address - Phone:706-429-0055
Mailing Address - Fax:
Practice Address - Street 1:506 RIVER SOUND LN
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0727
Practice Address - Country:US
Practice Address - Phone:706-429-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine