Provider Demographics
NPI:1992736417
Name:VAWRYK BUTTON, NADJA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NADJA
Middle Name:
Last Name:VAWRYK BUTTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 R. E. JENNINGS AVE. NE
Mailing Address - Street 2:P.O. DRAWER R
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813
Mailing Address - Country:US
Mailing Address - Phone:229-725-2172
Mailing Address - Fax:229-725-2196
Practice Address - Street 1:55 RE JENNINGS AVE SE
Practice Address - Street 2:P.O. DRAWER R
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-8722
Practice Address - Country:US
Practice Address - Phone:229-725-2172
Practice Address - Fax:229-725-2196
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00804363A00000X
GA005737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100409590AMedicaid
KS101706OtherBCBS
KS101706OtherBCBS
P48155Medicare UPIN