Provider Demographics
NPI:1790752228
Name:SANTOS-VEGA, MADELAINE ODETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELAINE
Middle Name:ODETTE
Last Name:SANTOS-VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3737
Mailing Address - Country:US
Mailing Address - Phone:229-924-8636
Mailing Address - Fax:229-924-8786
Practice Address - Street 1:609 EAST LAMAR STREET
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3737
Practice Address - Country:US
Practice Address - Phone:229-924-8636
Practice Address - Fax:229-924-8786
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74351208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7050065OtherHUMANA HEALTH PLAN
PR20045SAOtherTRIPLE SSS