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NPI Code Detail

MEDICARE: SOUTH GEORGIA VASCULAR INSTITUTE

MEDICARE: SOUTH GEORGIA VASCULAR INSTITUTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist056092GA

General Provider Information

NPI Number : 1609062215
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH GEORGIA VASCULAR INSTITUTE
Provider Business Mailing Address
First Line : 903 S BROAD ST
Second Line :
City : THOMASVILLE
State : GA
Zip : 31792-6114
Country : US
Telephone Number : 229-551-0024
Fax Number : 229-551-0254
Provider Business Practice Location Address
First Line : 903 S BROAD ST
Second Line :
City : THOMASVILLE
State : GA
Zip : 31792-6114
Country : US
Telephone Number : 229-551-0024
Fax Number : 229-551-0254
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. ROBERT LEWUS CIRILLO JR.
Credential : M.D.
Telephone Number : 229-551-0024
Provider Enumeration Date : 09/18/2007
Last Update Date : 09/18/2007

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Directions to “SOUTH GEORGIA VASCULAR INSTITUTE ” Practice Location

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