Provider Demographics
NPI:1457513186
Name:VLADESCU, DRAGOS SORIN (MD)
Entity Type:Individual
Prefix:
First Name:DRAGOS
Middle Name:SORIN
Last Name:VLADESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2594 LOGANVILLE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7848
Mailing Address - Country:US
Mailing Address - Phone:678-225-4999
Mailing Address - Fax:
Practice Address - Street 1:2594 LOGANVILLE HWY STE 101
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-7848
Practice Address - Country:US
Practice Address - Phone:678-225-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092742207Q00000X
GA66098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111147HMedicaid