Healthcare Provider Details

I. General information

NPI: 1881504215
Provider Name (Legal Business Name): GEORGIA PROFESSIONAL MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 WINN WAY STE 220
DECATUR GA
30030-1752
US

IV. Provider business mailing address

304 WAINWRIGHT DR STE 120
NORTHBROOK IL
60062-1919
US

V. Phone/Fax

Practice location:
  • Phone: 404-418-4328
  • Fax:
Mailing address:
  • Phone: 847-257-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YAN KATSNELSON
Title or Position: OWNER
Credential: MD
Phone: 847-774-5300