Provider Demographics
NPI:1992180517
Name:VEGA, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-419-1165
Mailing Address - Fax:404-419-1164
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 1100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4795
Practice Address - Country:US
Practice Address - Phone:404-851-2300
Practice Address - Fax:770-205-5291
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA216789363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner