Healthcare Provider Details

I. General information

NPI: 1063903078
Provider Name (Legal Business Name): SOUTH ATLANTA VASCULAR INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 MT. ZION PARKWAY
STOCKBRIDGE GA
30281
US

IV. Provider business mailing address

4045 MT. ZION PARKWAY
STOCKBRIDGE GA
30281
US

V. Phone/Fax

Practice location:
  • Phone: 770-919-5238
  • Fax: 470-781-5393
Mailing address:
  • Phone: 770-919-5238
  • Fax: 470-781-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number70519
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number66855
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID WILLIAM ALLISON
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 770-919-5238