Provider Demographics
NPI:1538522784
Name:VLASENKO, ARTYOM VLADIMIR (MD)
Entity type:Individual
Prefix:DR
First Name:ARTYOM
Middle Name:VLADIMIR
Last Name:VLASENKO
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 1:4700 WATERS AVE
Mailing Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE EDUCATION
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-7173
Mailing Address - Fax:
Practice Address - Street 1:1101 LEXINGTON AVE
Practice Address - Street 2:CENTER FOR INTERNAL MEDICINE
Practice Address - City:SVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA82177208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program