Healthcare Provider Details

I. General information

NPI: 1134407158
Provider Name (Legal Business Name): COLUMBUS VASCULAR CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 WOODRUFF RD STE 17
COLUMBUS GA
31904-6091
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD STE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-8999
  • Fax: 706-221-8809
Mailing address:
  • Phone: 727-474-0090
  • Fax: 727-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number54214
License Number StateGA

VIII. Authorized Official

Name: MS. JANET R DEES
Title or Position: MANAGING MEMBER
Credential:
Phone: 727-474-0090