Healthcare Provider Details

I. General information

NPI: 1891975470
Provider Name (Legal Business Name): METRO VASCULAR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N DECATUR RD STE 210 SUITE 210
DECATUR GA
30033-6132
US

IV. Provider business mailing address

2675 N DECATUR RD SUITE 210
DECATUR GA
30033-6131
US

V. Phone/Fax

Practice location:
  • Phone: 404-292-5938
  • Fax:
Mailing address:
  • Phone: 404-292-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number018771
License Number StateGA

VIII. Authorized Official

Name: ALBERT WILDSTEIN, MD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 404-292-5938