Provider Demographics
NPI:1518435395
Name:VOGT, PAIGE NICOLE (PAC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICOLE
Last Name:VOGT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:NICOLE
Other - Last Name:SNEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:4800 OLDE TOWNE PKWY STE 430
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4424
Mailing Address - Country:US
Mailing Address - Phone:770-292-6500
Mailing Address - Fax:770-292-6535
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 430
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4424
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant