Healthcare Provider Details

I. General information

NPI: 1265921183
Provider Name (Legal Business Name): VASCULAR SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MESA VALLEY WAY STE 185
AUSTELL GA
30106-6856
US

IV. Provider business mailing address

60 CHASTAIN CENTER BLVD NW STE 66
KENNESAW GA
30144-5598
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-8315
  • Fax:
Mailing address:
  • Phone: 770-423-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RACHEL RAYES
Title or Position: MGR
Credential:
Phone: 770-423-0595