Healthcare Provider Details

I. General information

NPI: 1922169846
Provider Name (Legal Business Name): COMPREHENSIVE VASCULAR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 BURLEYSON RD SUITE 202
DALTON GA
30720-3094
US

IV. Provider business mailing address

1109 BURLEYSON RD SUITE 202
DALTON GA
30720-3094
US

V. Phone/Fax

Practice location:
  • Phone: 706-259-3336
  • Fax: 706-370-7715
Mailing address:
  • Phone: 706-259-3336
  • Fax: 706-370-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number047329
License Number StateGA

VIII. Authorized Official

Name: IAN NEIL HAMILTON JR.
Title or Position: OWNER
Credential: M.D.
Phone: 706-259-3336