Provider Demographics
NPI:1609844067
Name:VACHTSEVANOS, CHERI OWENS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERI
Middle Name:OWENS
Last Name:VACHTSEVANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:667 LANIER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2059
Mailing Address - Country:US
Mailing Address - Phone:770-532-7501
Mailing Address - Fax:770-532-8322
Practice Address - Street 1:667 LANIER PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2059
Practice Address - Country:US
Practice Address - Phone:770-532-7501
Practice Address - Fax:770-532-8322
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047817207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00136139OtherRAILROAD MEDICARE
GA00903515AMedicaid
GA208354OtherBLUE CROSS BLUE SHIELD
GA00903515AMedicaid
GAH63972Medicare UPIN