Provider Demographics
NPI:1710708532
Name:VEGA, GRACIELA ARMANDA (NP)
Entity type:Individual
Prefix:MS
First Name:GRACIELA
Middle Name:ARMANDA
Last Name:VEGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SUMMER LEIGH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7114
Mailing Address - Country:US
Mailing Address - Phone:770-317-7195
Mailing Address - Fax:
Practice Address - Street 1:117 SUMMER LEIGH DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7114
Practice Address - Country:US
Practice Address - Phone:770-317-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2024055124363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health