Provider Demographics
NPI:1689086316
Name:RAGUKONIS, VANESSA EVA (DO)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:EVA
Last Name:RAGUKONIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:EVA STETSON
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3820 WINDERMERE PKWY STE 603
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3820 WINDERMERE PKWY STE 603
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7020
Practice Address - Country:US
Practice Address - Phone:678-607-8334
Practice Address - Fax:678-737-1823
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-17262084P0800X
GA928432084P0800X
TXT92192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN