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NPI Code Detail

MEDICARE: PREFERRED VASCULAR SERVICES SOUTHEAST LLC

MEDICARE: PREFERRED VASCULAR SERVICES SOUTHEAST LLC
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
12085R0204XVascular & Interventional Radiology Physician
22086S0129XVascular Surgery Physician

General Provider Information

NPI Number : 1861992976
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREFERRED VASCULAR SERVICES SOUTHEAST LLC
Provider Business Mailing Address
First Line : 9140 CORSEA DEL FONTANA WAY
Second Line :
City : NAPLES
State : FL
Zip : 34109-4397
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5461 HILLANDALE DR STE 210
Second Line :
City : LITHONIA
State : GA
Zip : 30058-4842
Country : US
Telephone Number : 770-981-8477
Fax Number : 770-981-8908
Authorized Official
Title or Position : OFFICER AND AUTHORIZED OFFICIAL
Name : JENNIFER BOYD BALDOCK
Credential :
Telephone Number : 615-234-5954
Provider Enumeration Date : 02/15/2018
Last Update Date : 02/06/2026

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Directions to “PREFERRED VASCULAR SERVICES SOUTHEAST LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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