Provider Demographics
NPI:1154620110
Name:VAXCARE GEORGIA LLC
Entity type:Organization
Organization Name:VAXCARE GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-829-8550
Mailing Address - Street 1:4401 S ORANGE AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6946
Mailing Address - Country:US
Mailing Address - Phone:888-829-8550
Mailing Address - Fax:888-843-7191
Practice Address - Street 1:989 GOVERNORS LN
Practice Address - Street 2:SUITE 160
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1173
Practice Address - Country:US
Practice Address - Phone:859-514-5547
Practice Address - Fax:859-514-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty