Provider Demographics
NPI:1194707398
Name:VARGAS MORRIS, FAYE (MD)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:VARGAS MORRIS
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 1:2451 CUMBERLAND PKWY SE STE 3863
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6136
Mailing Address - Country:US
Mailing Address - Phone:678-305-1700
Mailing Address - Fax:678-766-1744
Practice Address - Street 1:767 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2625
Practice Address - Country:US
Practice Address - Phone:678-305-1700
Practice Address - Fax:678-766-1744
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229290207R00000X
GA061869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02441367Medicaid
GA627197738DMedicaid
NY02441367Medicaid
GA20211I2967Medicare PIN
GA627197738DMedicaid