Provider Demographics
NPI:1558424408
Name:VARGO, JAMES DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DENNIS
Last Name:VARGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:314 MAXWELL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2011
Mailing Address - Country:US
Mailing Address - Phone:678-772-5555
Mailing Address - Fax:770-442-1915
Practice Address - Street 1:314 MAXWELL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2011
Practice Address - Country:US
Practice Address - Phone:678-772-5555
Practice Address - Fax:770-442-1915
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0120882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000088888CMedicaid
GA000088888CMedicaid