Healthcare Provider Details

I. General information

NPI: 1114083532
Provider Name (Legal Business Name): VASCULAR SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WHITCHER ST NE STE 2100
MARIETTA GA
30060-1179
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 770-423-0595
  • Fax: 770-423-0598
Mailing address:
  • Phone: 770-423-0595
  • Fax: 770-423-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHEL REYES
Title or Position: CPC
Credential:
Phone: 678-388-1621