Individual
VITO JOHN BAGNATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
420 CHARTER BLVD, SUITE 103, MACON, GA 31210-4854
(478) 471-8484
(478) 471-8487
Mailing address
420 CHARTER BLVD, SUITE 103, MACON, GA 31210-4854
(478) 471-8484
(478) 471-8487
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
45711
GA
207RB0002X
Obesity Medicine (Internal Medicine) Physician
45711
GA
207RG0100X
Gastroenterology Physician
45711
GA
208600000X
Surgery Physician
Primary
45711
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00798663A
—
GA
Enumeration date
09/29/2005
Last updated
04/25/2025
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